The capacity to estimate and manage risk is arguably “the revolutionary idea that defines the boundary between modern times and the past”,1 underpinning decisions in financial and commodity markets, insurance, engineering, and public health. Yet the risk of an individual developing a specific condition over a fixed period of time is a relatively new concept for clinical decision making. A recent spate of publications2-4 on the presentation of cardiovascular risk estimates suitable for clinical use is joined by Jones and colleagues' contribution published in a recent issue of Heart.5

Their study compares the accuracy of five tables or charts of cardiovascular risk derived from the original Framingham equations. Three of the tables are from national guidelines (joint British, New Zealand, and Canadian), one is from the joint European cardiac societies and one from Ramsay's team in Sheffield. They assess the tables using data from almost 700 patients in 12 Birmingham general practices. For each patient, risk is predicted with each table and compared to the predictions directly calculated by the Framingham equations.

It is reassuring that the charts in the revised joint British guidelines compared well with results from the original equations, as these guidelines inform treatment decisions in the national service framework on coronary heart disease.6 However, questions remain about the use of risk charts or tables in routine clinical practice.