There is uncertainty whether current strategies for providing CVD risk scores  affect CVD events .
Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm .
BACKGROUND The current paradigm for cardiovascular disease ( CVD ) emphasises absolute risk assessment to guide treatment decisions in primary prevention .
Although the derivation and validation of multivariable risk assessment tools , or CVD risk scores , have attracted considerable attention , their effect on clinical outcomes is uncertain .
OBJECTIVES To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes , risk factor levels , preventive medication prescribing , and health behaviours .
Effects of a patient oriented decision aid for prioritising treatment goals in diabetes: pragmatic randomised controlled trial
Objective To assess the effects of a patient oriented decision aid for prioritising treatment goals in diabetes compared with usual care on patient empowerment and treatment decisions . Design Pragmatic r and omised controlled trial . Setting 18 general practice s in the north of the Netherl and s. Participants 344 patients with type 2 diabetes aged ≤65 years at the time of diagnosis and managed in primary care between April 2011 and August 2012 : 225 were allocated to the intervention group and 119 to the usual care group . Intervention The intervention comprised a decision aid for people with diabetes , with individually tailored risk information and treatment options for multiple risk factors . The aid was intended to empower patients to prioritise between clinical domains and to support treatment decisions . It was offered to participants before a regular diabetes check-up and to their healthcare provider during the consultation . Four different formats of the decision aid were included for additional explorative analyses . Main outcome measures The primary outcome was the effects on patient empowerment for setting and achieving goals . The secondary outcomes were changes in the prescribing of drugs to regulate glucose , blood pressure , lipids , and albuminuria . Data were collected through structured question naires and automated data extraction from electronic health records during six months before and after the intervention . Results Of all intervention participants , 103 ( 46 % ) reported to have received the basic elements of the intervention . For the primary outcome analysis , 199 intervention and 107 control patients with sufficient baseline and follow-up data could be included . The mean empowerment score increased 0.1 on a 5 point scale in the overall intervention group , which was not significantly different from that of the control group ( mean difference after adjusting for baseline 0.039 , 95 % confidence interval −0.056 to 0.134 ) . Lipid regulating drug treatment was intensified in 25 % of intervention and 12 % of control participants with increased cholesterol levels , which did not reach significance when the intervention was compared with the usual care group ( odds ratio 2.54 , 95 % confidence interval 0.89 to 7.23 ) . Prespecified explorative analyses showed that this effect was significant for the printed version of the decision aid in comparison to usual care ( 3.90 , 1.29 to 11.80 ) . No relevant or significant changes were seen for other treatments . Conclusion We found no evidence that the patient oriented treatment decision aid  improves patient empowerment by an important amount . The aid was not used to its full extent in a substantial number of participants . Trial registration Dutch trial register NTR1942
There is uncertainty whether current strategies for providing CVD risk scores  affect CVD events .
Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm .
BACKGROUND The current paradigm for cardiovascular disease ( CVD ) emphasises absolute risk assessment to guide treatment decisions in primary prevention .
Although the derivation and validation of multivariable risk assessment tools , or CVD risk scores , have attracted considerable attention , their effect on clinical outcomes is uncertain .
OBJECTIVES To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes , risk factor levels , preventive medication prescribing , and health behaviours .