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(Circulation. 2005;111:542-545.)
© 2005 American Heart Association, Inc.

Editorial

Age and Time Need Not and Should Not Be Eliminated From the Coronary Risk Prediction Models

Ramachandran S. Vasan, MD; Ralph B. D’Agostino, Sr, PhD

From the Framingham Heart Study (R.S.V., R.B.D.), Framingham, Mass; the Department of Mathematics (R.B.D.), Boston University, Boston, Mass; and the Department of Preventive Medicine, Cardiology Section (R.S.V.), Boston University School of Medicine, Boston.

Correspondence to Ramachandran S. Vasan, MD, The Framingham Heart Study, 73 Mt Wayte Ave, Framingham, MA 01702-5803. E-mail vasan@bu.edu

Key Words: Editorials • coronary disease • risk factors • prevention • prognosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Risk assessment, risk communication, and risk management are 3 fundamental steps in the primary and secondary prevention of coronary heart disease (CHD). Consequently, national and international guidelines^1–4 have been formulated to assist clinicians in providing standardized care for treating coronary risk factors. These guidelines are consistent with the best available scientific evidence on risks of developing CHD and potential strategies to reduce those risks via nonpharmacological and pharmacological interventions. One of the critical concepts on which contemporary guidelines are founded is the notion that the choice and intensity of an intervention strategy should in part be based on the underlying risk—ie, the absolute risk of experiencing a CHD event during a short-term period. This is typically estimated as the 10-year risk of CHD for a man or a woman of a specific age.^1,3,4 In this issue of Circulation, Ridker and Cook⁵ present an argument to eliminate both the age and the time dependency of CHD risk prediction algorithms. On the basis of the objectives of current guidelines and risk prediction algorithms, we disagree with the suggestion made by Ridker and Cook. We submit that not only is removal of age and time from the risk prediction equations not necessary, but, to the contrary, such removal may be inappropriate. Furthermore, as we demonstrate below, the objectives desired by Ridker and Cook are already available with the existing prediction algorithms and often have been incorporated into the standard use of the current guidelines.

See p 657

Before we proceed, it would . . . [Full Text of this Article]

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