Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
====
"I hear and I forget. I see and I remember. I do and I understand." - Confucius
====
"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
====
" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
====
"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
====
"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
====
"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
====
"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
====
"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
====
"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
====
"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
====
"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
====
"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
====
"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
====
"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
====
"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
====
"There are no facts, only interpretations." - Nietzsche
====
"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
====
"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
Defining secondary prevention
6 Feb2009
Our favorite Dinosaur asks a great question:
Secondary prevention is not controversial; primary prevention is very controversial.
Where exactly do you draw the line defining the difference between the two? What kind of “cardiac event” tips a patient over into secondary vs. primary prevention? Clearly a documented MI counts, but what about ACS? Is asymptomatic non-obstructing coronary disease enough of an “event”?
As I understand secondary prevention, we treat patients who have either documented coronary artery disease or a coronary artery disease equivalent (type II DM). I clearly would treat patients with any acute coronary syndrome. I would treat type II DM, as they generally have CAD even if we have not yet proven it.
Asymptomatic coronary disease is the one difficult one to consider. It is easy if they happen to also have diabetes, but let’s assume that the patient had a cardiac CT and subsequently a cath. I would probably make my decision based on 2 other factors. If the LDL is elevated and there are no other risk factors I would likely use a statin. If the patient had an abnormal cardiac stress test I would probably use a statin.
When considering primary prevention I was considering patients like me. I am old enough to be of high risk, but have no other risk factors. I happen to have a low LDL, but I have many friends who have LDL in the 130-160 range. Many physicians put them on statins. I would not. Perhaps I would now check CRP and start the statin if that were also elevated, but I do not believe the data are yet overwhelming.
The good news remains that both simvastatin and pravstatin are "Wal-Mart" drugs, so the cost implications are much more reasonable. The fuzzy area between primary and secondary prevention represents a situation in which we need clinical judgment. I do not believe that we have enough data for hard rules.
Related posts:
- Wherefore statins?
- Prevention does save money
- No heart disease – no aspirin
- How to save health care dollars
- Calcium not sufficient for secondary osteoporosis prevention
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants