Cardiovascular Primary Prevention Choice (under construction)

The CV Primary Prevention Choice tool is under construction for integration within electronic medical record systems and implementation in primary care settings. An NIH-funded hybrid implementation trial is underway led by Dr. Jennifer Ridgeway.

LEGACY TOOLS (No longer necessarily up-to-date)

Statin/Aspirin Choice Decision Aid

The risk reductions attributed to statins and decision aids come from systematic reviews of randomized trials of primary prevention of coronary events with statins (25-30% reduction in risk of coronary events) and aspirin (15-20% reduction in coronary events).

The risk reduction in coronary events with fixed standard dose statins (atorvastatin 10 mg, simvastatin 40 mg, pravastatin 40 mg, rosuvastatin 5 mg) has been stable for years and was recently documented in a systematic review to be 25%, with high dose statins (2-3 times standard dose) adding about 15% relative risk reduction (i.e., 40% risk reduction).

Low-dose aspirin can reduce coronary events by about 20-25% and can impact the risk and outcomes of colon cancer and other cancers.

Tools:

Risk calculators:  

  • Framingham: 10-year Coronary Heart Disease Risk  – Wilson et al (1998)
statin-choice

Decision aids to be used during the encounter:

Key Assumptions:

  • The risk reductions attributed to statins and decision aids come from systematic reviews of randomized trials of primary prevention of coronary events with statins (25-30% reduction in risk of coronary events) and aspirin (15-20% reduction in coronary events).
  • The risk reduction in coronary events with fixed standard dose statins (atorvastatin 10 mg, simvastatin 40 mg, pravastatin 40 mg, rosuvastatin 5 mg) has been stable for years and was recently documented in a systematic review to be 25%, with high dose statins (2-3 times standard dose) adding about 15% relative risk reduction (i.e., 40% risk reduction).

Decision aids in practice:  

Additional resources:

Statin/Aspirin Choice

Decision aids used in a 98-patient randomized trial (specialty care and independently by another group in a primary care clinic in New York) publications:

NIH-funded Decision Aids in Diabetes (DAD) trial publications:

Aspirin Choice

  • Kent DM, Shah ND. Personalizing evidence-based primary prevention with aspirin: Individualized risks and patient preferences. Circ Cardiovasc Qual Outcomes 2011;4:260-262.

DISCLAIMER:  No decision aid replaces the conversation patients should have with their clinicians to make important, clinical decisions.  Use of these decision aids carries no liability to its developers or to the Mayo Clinic Foundation for Education and Research.

Feedback
If you download our decision aids, we would love to hear from you!  Please send us a note at kerunit@mayo.edu to let us know who you are, why you are interested in the decision aid(s), and how you plan to use them.  Remember to check back to this page periodically to make sure you are using the most up-to-date version(s).