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Editor's Note
April 8, 2013

Considering Baseline Risk When Prescribing Pharmacologic TreatmentComment on “A National Survey of the Treatment of Hyperlipidemia in Primary Prevention”

JAMA Intern Med. 2013;173(7):588. doi:10.1001/jamainternmed.2013.286

Physicians do not follow clinical guidelines for many reasons. One common reason is that the guidelines may be complicated and hard to remember at point of care. The findings from this survey of physicians are consistent with that possibility. Physicians reported that they would prescribe statins to people at such low risk that our professional guidelines do not suggest treating them with medications. Certainly, this survey reflects my clinical experience. I commonly see women in my practice who have Framingham risk scores well below 10%, yet were prescribed a statin for a cholesterol level around 200 mg/dL; these women are experiencing muscle aches and pains related to the statins and are worried about an imminent myocardial infarction. One solution may be readily available: robust decision aids to make it easy for physicians to calculate risk and appropriately prescribe statins. Until then, this survey reminds us to consider baseline risk when considering whether to initiate pharmacologic treatment.

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