(Circulation. 1998;97:1761-1762.)
© 1998 American Heart Association, Inc.
Problems on the Pathway From Risk Assessment to Risk Reduction
Philip Greenland, MD;
Scott Grundy, MD, PhD;
Richard C. Pasternak, MD;
; Claude Lenfant, MD
From the Department of Preventive Medicine, Northwestern University
Medical School (P.G.), Chicago, Ill; Center for Human Nutrition, University of
Texas Southwestern Medical Center at Dallas (S.G.); Cardiovascular Division,
Departments of Medicine, Cardiac Unit, Massachusetts General Hospital
(R.C.P.), Boston, Mass; and National Heart, Lung, and Blood Institute (C.L.),
Bethesda, Md.
Correspondence to Philip Greenland, MD, Department of Preventive Medicine, Northwestern University Medical School, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611. E-mail p-greenland@nwu.edu
Key Words: Editorials • risk factors • coronary disease
Assessment of risk
and reduction of risk are well-accepted responsibilities of the
physician. The pathway from assessment of risk to reduction of risk
basically involves three steps: (1) measurement of risk factors and
collection of clinical data relevant to patient risk; (2)
interpretation of risk-related data with estimation of risk in absolute
terms (eg, risk of an event per year) as well as relative terms (ie,
low, intermediate, or high compared with others of the same age and
sex); and (3) on the basis of risk estimation results, intervention to
minimize disease risk or to prevent risk factor development in the
future. Although the process seems reasonably straightforward, problems
occur at each step that weaken the link between risk assessment and
risk reduction. Such problems occur in assessment of CVD risk
estimation and reduction just as in most other areas of medical
practice in spite of the availability of excellent data relating to CVD
risk estimation from the Framingham Heart Study and other similar data
sets.1
Periodic measurement of CVD risk factors in healthy people (step
1) is routinely recommended by the AHA, the ACC, and the NHLBI, in
addition to other authorities on disease
prevention.2 3 4 Blood lipid measurements, blood
pressure readings, age, sex, cigarette smoking and diabetic status, ECG
findings, and other risk predictors can be recorded or measured in
the office setting and can be entered into risk assessment
algorithms.1 5 Unfortunately, studies show that
physicians frequently fail to collect these simple and well-accepted
data elements in the course . . . [Full Text of this Article]
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