A letter to GPs
Guidelines
We are increasingly told to follow guidelines.
Two friends of mine decided as part of their health care to evaluate their cardiac risk.
They had read widely of the current CVD risk models and wanted a more definitive approach.
I suggested the option of ultrasonography of larger blood vessels such as carotids, aorta and femorals as a direct look at the endothelium (the cells lining the inside of the blood vessel) and intimal (vessel support structures) status, asking, is there evidence of an active pathological process. This a well proven assessment tool to assess risk, for example of stroke or leg ischaemia and by association cardiac artery disease.
A second suggestion was a cardiac calcium score with a follow up of a CT Angiogram if indicated, pointing out the radiation risk.
They went armed with this info to their GP.
What bloody disaster!
With much reluctance and the mention of how much it would cost, these two friends who were recommended long term statins finally got their evaluation after referral to a cardiologist and again finding some reluctance.
These friends were in their late 60s.
The result showed both had negative parameters for carotid vascular disease and both had chosen to have CT Calcium scores.
Not a speck of calcium so with great relief they went for follow up in the expectation that their statin meds could be safely abandoned.
To my profound disbelief but saddening secret expection one GP said stay on them as “I have worked in a stroke ward and you don’t want a stroke”and the other suffered the banal comment, your cholesterol off medication is high so stay on it.
Arrogant bullying comes to mind.
Some will say that the clean arteries here are a result of statins however the statin had been prescribed for a relatively short period or secretly not taken (brave person).
Mindless prescribing is reprehensible.
You have better options of evaluation techniques (other than the failed predictive tools you are incentivised to use by your sometimes dysfunctional Ministry of Health), options of which you are obligated to inform you clients.
Take a look at PWA for example and developed your own screening opinion.
Cheers
Retired Alive GP
John Cook