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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 . . . [Full Text of this Article]

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