The SHAPE Guideline: Why Primary Care Physicians Should Embrace It

The vast majority of patients who have traditional cardiovascular disease risk factors but lack overt evidence of atherosclerotic disease (i.e., “primary prevention” patients) are managed by primary care physicians. A relatively small percentage of these patients currently achieve their JNC-VII and/or NCEP ATP-III goals, a reflection of both patient-specific and physician-related barriers. Many patients have unrealistic expectations of what can be achieved through diet alone, lack an appreciation of the potential benefit of pharmaceuticals, and/or have an inappropriate fear of medication side effects, all of which contribute to resistance to medication initiation and poor long-term adherence. This perspective is not easily changed as primary care physicians have difficulty in persuasively communicating long-term cardiovascular risks and the benefit of intervention. Most primary care physicians do not use Framingham Risk Scores to stratify higher risk patients. As time constraints make the scoring system impractical to utilize consistently, it provides an incomplete assessment of risk, and the derived 10 year-risk of having an event is difficult to interpret meaningfully for patients. Furthermore, many primary care physicians perceive current guidelines as being too complicated and find “optional” goals confusing. Thus, a more efficient means of identifying high-risk patients, coupled with simplified guidelines containing succinct, clear recommendations for LDL-C target levels and therapeutic interventions, would likely improve the CVD prevention goal attainment rates in these at-risk patients. The SHAPE Guideline addresses many of the barriers primary care physicians face in striving to optimally manage their dyslipidemic patients. Positive screening tests will help physicians to identify those patients who need more aggressive treatment, and likewise help to motivate at-risk patients to comply with their physician’s treatment recommendations. The heightened risk awareness afforded by a positive screening test will thereby enhance patient compliance and clearly improve the treatment of this high-risk population.