BEHAVIORAL ISSUES IN THE EFFICACY VERSUS EFFECTIVENESS OF PHARMACOLOGICAL AGENTS IN THE PREVENTION OF CARDIOVASCULAR-DISEASE

A number of pharmacological interventions are now recommended for the prevention of cardiovascular disease, based on the results of randomiz ed controlled trials. These include antihypertensive drugs, lipid-lowe ring agents, antiplatelet and anticoagulant drugs, estrogen replacemen t therapy, beta-blockers, and angiotensin converting enzyme(ACE) inhib itors. It is likely that additional pharmacological interactions will soon be proven efficacious. Despite the strength of this evidence and the development of clinical guidelines incorporating their use, a surp risingly low proportion of patients are actively treated with these ag ents. There may be a variety of explanations for this, including barri ers at the level of the patient, health care provider, and health care institution. Finally, a number of questions remain as to the optimal combination of interventions, both behavioral and pharmacological, whi ch will yield maximal reduction in risk. The description of the factor s which reduce the effectiveness of pharmacologic interventions below the efficacy demonstrated in randomized clinical trials should be a fe rtile area for epidemiologic and behavioral research.