What to say and how to say it

PURPOSE OF REVIEW: Current guidelines for cholesterol treatment emphasize the importance of engaging patients in a risk-benefit discussion prior to initiating statin therapy. RECENT FINDINGS: Although current risk prediction algorithms are well defined, there is less data on how to communicate with patients about cardiovascular disease risk, benefits of treatment, and possible adverse effects. SUMMARY: We propose a four-part model for effective shared decision-making: 1) Assessing patient priorities, perceived risk, and prior experience with cardiovascular risk reduction; 2) Arriving at a recommendation for therapy based on the patient's risk of disease, guideline recommendations, new clinical trial data, and patient preferences; 3) Communicating this recommendation along with risks, benefits, and alternatives to therapy following best practices for discussing numeric risk; and 4) Arriving at a shared decision with the patient with ongoing reassessment as risk factors and patient priorities change.