TEC: Evidence Based Therapeutics
Therapeutics Education Collaboration
Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

Episode 3: The Risky Business of CVD Risk Assessment

In the third session, we discuss the advantages and disadvantages of three methods to present “benefit”: changes in risk calculators, using relative risk, or the absolute benefit. We review the challenges of absolute vs relative risk (or relative vs absolute truth) and discuss patient expectations in regards to the medical miracle of prevention. The duration of therapy is put in context of the epoch time frames of risk calculators and studies.

Show Notes


CVD is cardiovascular disease and typically refers to the combination of CHD (coronary heart disease – fatal and non-fatal MIs and sometimes angina) PLUS cerebrovascular disease (fatal and non-fatal strokes – and sometimes TIAs) PLUS (sometimes) other conditions (heart failure, peripheral vascular disease)

Calculating benefit

  1. Change the factor and recalculate the chance of CVD
  2. Use the relative benefits seen in clinical trials (typically 5 years in duration) and apply them to the chance calculated for your patient
  3. Avoid the use of CDV calculators and just use the absolute benefits seen in clinical trials

A synopsis of the relative benefit of drugs

  • Statins ? 30%? in CHD (0%? in women)? 5 years
  • BP ? 40 %? in strokes and ? 20%? in CHD ? 5 years
  • Metformin ? 35%? in CHD and stroke ? 8-10 years

A synopsis of the absolute benefit of drugs

Statins over 5 years in a post MI patient Coronary events ?4% (15% to 11%) Death ?2% (12% to 10%) Strokes ?1% (5% to 4%) Treating a Blood Pressure of 160 /100 mmHg for 5 years CVD ? 1% (4% to 3%)

  • Therapeutics Letter #62.
  • Absolute benefit of statins over approx 5 years

    Major coronary events (%)* Death (%) Strokes (%) FROM WHAT CVD TO WHAT CVD (%)
    Primary 1-1.5* 8-9 to 7
    Diabetes 2 1-1.5 10 to 7
    Secondary 4 2 1 20 to 15

    * just in males and NO difference in overall serious adverse events

    Listening to this episode is for premium podcast members only. If you already have a membership, login to your account. If you aren't yet a premium subscriber, sign up today!


    BS Medicine Podcast

    The 2024 MEME Conference – May 24-25, 2024


    Making Evidence Matter For Everyone | May 24 & 25, 2024
    From the clinicians who brought you the Best Science Medicine Course and the Meds Conference, as well as the BS Medicine Podcast and Tools for Practice




    Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.


    BedMed: The High Blood Pressure Study

    This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)

    PEER Tools


    Recent Posts