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Predicting and reducing cardiovascular risk
  1. Department of General Practice and Primary Care
  2. St Bartholomew's and Royal London Hospital Medical School
  3. Queen Mary, University of London
  4. Mile End Road
  5. London E1 4NS, UK

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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.

Improving effectiveness of treatment

Decisions to initiate treatment for the prevention of cardiovascular disease in individual patients requires three types of information: evidence from trials, the level of risk (based upon the biological and behavioural characteristics of the individual), and his or her view on the initiation and continuation of treatment. Trials determine whether the benefits outweigh the hazards of treatment for a group of patients at a particular level of risk, and risk may be quantified …

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