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Heart Forecast for cardiovascular risk assessment
  1. Perviz Asaria1,
  2. Darrel P Francis2
  1. 1Department of Epidemiology and Biostatistics. Imperial College School of Public Health, Imperial College London, London, UK
  2. 2International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Dr Perviz Asaria, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PF, UK; p.asaria{at}ic.ac.uk

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People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. Orwell

Risk communication has long been acknowledged to be fraught with pitfalls and subject to manipulation. The magnitude of harm and the publicity given to a risk can grossly sway perception of the problem. For example, risk of death from terrorism has a low lifetime probability of occurrence (well under 0.01%) but the harm is sufficiently clustered in time and space that it becomes newsworthy and therefore noted; in contrast, cardiovascular deaths have a high lifetime probability of occurrence (∼20–25%) but the harm is spread very thinly because each victim dies alone and out of the public eye.

Measures which are seen to be reasonable in preventing these varying classes of event have differing levels of acceptability. While it is widely considered acceptable to curtail personal freedoms to reduce the threat of rare but aggregated attack, restriction of personal choice of food in order to prevent the 2000 times more likely occurrence of cardiovascular disease (CVD) is almost universally considered unacceptable. The problem becomes amplified in primary prevention, where returns from intervention are low and accumulate over the long term, whereas the disutility incurred by forced lifestyle change or the side effects from drug treatment are immediate.

Choice of framing

Doctors and patients tend to view risks differently.1 Even the ‘15% 10-year risk of CVD’ benchmark used in many guidelines for starting preventive treatment, intrinsically means that only 15 out 100 people with similar risk profiles would develop a coronary event if left untreated. However, a patient may interpret this to mean that s/he has a low (or high) risk of CVD, depending on her/his prior internal perception of her/his …

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