Brian Firestone1, James W Mold. 1. Department of Family and Preventive Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Abstract
BACKGROUND: Benefits of interventions are usually reported as relative risk reductions. Absolute risk reductions (ARRs)-most relevant to individual patients-are reported less often. OBJECTIVES: Estimate ARRs for interventions in a patient with diabetes mellitus. METHODS: We used the Archimedes Risk Assessment Tool to estimate 10-year risks of myocardial infarction (MI), cerebrovascular accident (CVA), end-stage renal disease (ESRD), blindness, foot ulceration, and amputation, and to estimate the ARRs associated with controlling blood pressure (BP), blood sugar, and low-density lipoprotein (LDL) cholesterol levels; moderate exercise; and taking aspirin and a beta-blocker. Our hypothetical base case was a 65-year-old white man. Three other hypothetical patients were a 50-year-old white man, a 65-year-old white woman, and a 65-year-old black man. Each patient had a 5-year history of diabetes mellitus, a sedentary lifestyle, body mass index (BMI) of 28 kg/m2, BP of 140/90 mm Hg, LDL of 120 mg/dL, high-density lipoprotein (HDL) of 45 mg/dL, and glycosylated hemoglobin (HbA1c) of 10%. RESULTS: For the base case, the risks of MI (22.3%) and CVA (14.4%) far exceeded the risks of ESRD, blindness, and amputation. ARRs for interventions to reduce MI risk were: aspirin, 6.8%; HbA1c to 7%, 5.1%; moderate exercise, 2.7%; BP to 130/80 mm Hg, 1.4%; and LDL to 100 mg/dL, 1.4%. The female patient had a lower ARR for aspirin and a greater ARR for exercise. The black male patient had greater ARRs for both aspirin and exercise. Estimates were similar for CVA. CONCLUSION: Patients resembling our base case and its variations would probably benefit more from aspirin and moderate exercise than from all other interventions combined.
BACKGROUND: Benefits of interventions are usually reported as relative risk reductions. Absolute risk reductions (ARRs)-most relevant to individual patients-are reported less often. OBJECTIVES: Estimate ARRs for interventions in a patient with diabetes mellitus. METHODS: We used the Archimedes Risk Assessment Tool to estimate 10-year risks of myocardial infarction (MI), cerebrovascular accident (CVA), end-stage renal disease (ESRD), blindness, foot ulceration, and amputation, and to estimate the ARRs associated with controlling blood pressure (BP), blood sugar, and low-density lipoprotein (LDL) cholesterol levels; moderate exercise; and taking aspirin and a beta-blocker. Our hypothetical base case was a 65-year-old white man. Three other hypothetical patients were a 50-year-old white man, a 65-year-old white woman, and a 65-year-old black man. Each patient had a 5-year history of diabetes mellitus, a sedentary lifestyle, body mass index (BMI) of 28 kg/m2, BP of 140/90 mm Hg, LDL of 120 mg/dL, high-density lipoprotein (HDL) of 45 mg/dL, and glycosylated hemoglobin (HbA1c) of 10%. RESULTS: For the base case, the risks of MI (22.3%) and CVA (14.4%) far exceeded the risks of ESRD, blindness, and amputation. ARRs for interventions to reduce MI risk were: aspirin, 6.8%; HbA1c to 7%, 5.1%; moderate exercise, 2.7%; BP to 130/80 mm Hg, 1.4%; and LDL to 100 mg/dL, 1.4%. The female patient had a lower ARR for aspirin and a greater ARR for exercise. The black male patient had greater ARRs for both aspirin and exercise. Estimates were similar for CVA. CONCLUSION:Patients resembling our base case and its variations would probably benefit more from aspirin and moderate exercise than from all other interventions combined.
Authors: A A El-Sanhouri; R E Foster; M R Petersen; R K Hutchins; D M Miller; T M Evans; N Trichopoulos; C D Riemann Journal: Eye (Lond) Date: 2011-05-13 Impact factor: 3.775