Treat-to-target—mainstream or marketing?

Excerpt

‘Treat-to-target’ is an approach to the management of chronic disease that was initially developed in cardiovascular medicine. Informed by epidemiological data, individual risk factors for which treatments were available were identified (hypertension, dyslipidemia and diabetes in the case of cardiovascular disease). Calculators that incorporate these and other risk factors such as age and smoking were developed to estimate the risk over 5 to 10 years of major cardiovascular events (myocardial infarction, stroke and cardiovascular death). Informed by clinical trial data, treatment thresholds are determined and suitable and potentially attainable targets for each risk factor selected, though these may undergo revision in light of new data. The role of clinicians is to estimate their patients’ risk, persuade them that this is a worthwhile strategy and, based on periodic biomarker assessment (for example, blood pressure, LDL cholesterol and glycated haemoglobin), to amend the drug regimen to keep as close to the targets as possible. Although the therapeutic armamentarium is generally effective, issues of cost, safety and adherence mean that not everyone reaches the targets. However, there is a mass of evidence that such an approach can reduce the rate at which cardiovascular events happen. …