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(Circulation. 1999;99:2219-2222.)
© 1999 American Heart Association, Inc.

Correspondence

An Easier Approach to Estimating Risk of Coronary Heart Disease and Stroke

James P. McCormack, BSc(Pharm), PharmD

Associate Professor Faculty of Pharmaceutical Sciences, University of British Columbia, Clinical Pharmacist, St. Paul's Hospital, Vancouver, BC, Canada

Marc Levine, BSc(Pharm), PhD

Associate Professor Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

Robert E. Rangno, MSc, MD, FRCP(C)

Associate Professor, Departments of Medicine and Pharmacology University of British Columbia, Head, Clinical Pharmacology, St Paul's Hospital, Vancouver, BC, Canada

To the Editor:

In their article, Wilson et al¹ provide useful information that allows clinicians to predict coronary heart disease risk in patients without a history of heart disease. This is very much needed because primary care and specialty physicians typically overestimate patients' absolute heart disease risk and the expected benefits of drug therapy given for primary prevention.^{2 3}

To encourage clinicians to use this type of information, it must be easy to use and incorporate into a busy clinician's practice.⁴ In addition, it should facilitate clinicians' discussion of this information with their patients so that an informed decision about drug therapy or other risk reduction strategies can be made.

We recently developed⁵ a simple nomogram for estimating the risk of coronary heart disease and stroke in individual patients using the Framingham data from previous studies by these authors.^{6 7} Our method allows the clinician and patient to consider the impact of individual risk factors. In addition, it allows them to visualize the interplay between individual risk factors; easily add, remove, or modify risk factors; and observe the impact of changes on risk assessment.

Because modification of risk factors does not necessarily mean that cardiovascular risk will be reduced, we also provided clinicians with a table that provides examples of demonstrated risk reductions that allows the clinician to incorporate the evidence from well-designed clinical trials into the decision-making process

We encourage the Framingham group to present their risk prediction information in a more visual format rather than as a score sheet. This type of format is faster and easier to use and does not require summation of risk factor points and transfer of this information to tables. It allows the clinician and patient to visualize the potential effects of a combination of risk factors on the chance of coronary heart disease and the expected benefits of drug therapy given for primary prevention.

References

1. Wilson PWF, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847.[Abstract/Free Full Text]

2. Friedmann PD, Brett AS, Mayo-Smith MF. Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease. Ann Intern Med. 1996;124:414–421.[Abstract/Free Full Text]

3. Naylor DC, Chen E, Strauss B. Measured enthusiasm: does the method of reporting trial results alter perceptions of therapeutic effectiveness? Ann Intern Med. 1992;117:916–921.

4. Greenland P, Grundy S, Pasternak RC, Lenfant C. Problems on the pathway from risk assessment to risk reduction. Circulation. 1998;97:1761–1762.[Free Full Text]

5. McCormack JP, Levine M, Rangno RE. Primary prevention of heart disease and stroke: a simplified approach to estimating risk of events and making drug treatment decisions. Can Med Assoc J. 1997;157:422–428.[Abstract]

6. Anderson KM, Wilson PW, Odell P, Kannel W. An updated coronary risk profile: a statement for health professionals. Circulation. 1991;83:356–362.[Free Full Text]

7. D'Agostino RB, Wolf PA, Belanger AJ, Kannel WB. Stroke risk profile: adjustment for antihypertensive medication. Stroke. 1994;25:40–43.[Abstract]

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