Infográficos para decisão compartilhada no uso de estatinas em paciente de alto risco cardiovascular

Fernanda Karolinne Melchior Silva Pinto; Jardel Correa de Oliveira

doi:10.5712/rbmfc14(41)1809

Authors

Fernanda Karolinne Melchior Silva Pinto Preceptora do Programa de Residência em MFC da Unievangelica/GO
Jardel Correa de Oliveira Médico de Família e Comunidade Preceptor do programa de Residencia em Medicina de Família e Comunidade da ESP Secretaria Municipal de Saúde de Florianópolis

DOI:

https://doi.org/10.5712/rbmfc14(41)1809

Keywords:

Statins, Cardiovascular Diseases, Cerebrovascular Diseases, Primary Health Care, Decision Making

Abstract

Objectives: To elaborate infographics for shared-decision on the benefit and risk of the use of statins as primary prevention in patients with high cardiovascular risk. Methods: From the “NNT”, which analyzed the use of statins for primary prevention in low-risk cardiovascular individuals from meta-analyzes of the US Preventive Services Task Force (USPSTF) and Cochrane, we sought to define the risk balance and the benefit of such therapy in the primary prevention of people at high risk. Because the USPSTF and Cochrane had 10 different primary studies included in their analyzes and populations at varying cardiovascular risk, an additional search was conducted for systematic reviews and meta-analyzes published since the date of the Cochrane review (December 2012) through October 2017. We searched Medline via PubMed, the Virtual Health Library, Cochrane, and NHS Evidence for studies of people with a 10-year cardiovascular risk estimated at more than 10% with one more risk factor or more than 20% without history of previous cardiovascular disease, who compared statin use with placebo or no treatment. The outcomes should be the reduction of cardiovascular and cerebrovascular diseases, cardiovascular or general mortality and the occurrence of adverse events. Results: One hundred and twenty-five studies were found between meta-analyzes and site-based reviews from December 2012 to October 2017. One hundred and twenty-four studies were excluded for several reasons. Statins for primary prevention, 2012, with a population of 100% of diabetics with no prior cardiovascular events with absolute risk reduction (RRA) for fatal stroke of 0.78 percentage points/NNT 128 and Cardio/Cerebrovascular Diseases RRA 2.6 percentage points/NNT 39, cardiovascular. Regarding the reduction of general mortality (RR 0.79, 95% CI 0.58-1.08) and revascularization (RR 0.74, 95% CI 0.55-1.00), no significant statistical difference was found. Due to the limitations found in the systematic reviews evaluated, it was not possible to compile infographic data on the incidence of diabetes and abandonment of therapy. Thus, to elaborate the part related to damages, the Aspen ECR was selected, with a population of diabetics of high risk for the development of cardiovascular events, without previous events, as for myalgia with an increase in absolute risk (ARA) of 1.43 percentage points/NND 70 (RR 1.91, IC 95% 1.03-3.53). Conclusion: An infographic was elaborated, with and without statin, for non-fatal cardiocerebrovascular outcomes, fatal stroke, need for revascularization, general mortality and for the adverse occurrence of muscular symptoms. This instrument can be used in Primary Care during the clinical meeting for shared decision making, facilitating the understanding of the risks and benefits of statin use in patients at high cardiovascular risk (RCV 10% with at least one additional risk factor or > 20% in 10 years), in whom the statin prescription is considered.

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Author Biography

Fernanda Karolinne Melchior Silva Pinto, Preceptora do Programa de Residência em MFC da Unievangelica/GO

Graduada em medicina pela UFG. Médica de Família pela Escola Saúde Pública Florianópolis.

Preceptora do Programa de Residência em Medicina de Familia e Comunidade Unievangelica

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