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Assessing coronary risk
EDITOR,--Steven A Grover and colleagues compared estimates by doctors of gains in life expectancy as a result of a reduction in risk factors with those estimated from their computer model of prevention of coronary heart disease.1 The model they used is based on logistic regression analyses, using data from the Framingham heart study, the Canada health survey, and Canadian life tables.2 They calculated potential gains in life expectancy with intervention by applying to such a statistical model the levels of the risk factors before and after the intervention.
Three major problems are inherent in this approach. Firstly, the benefits of a reduction in risk factors may not be immediately apparent, since there is a substantial lag period before full benefits are achieved.3 Secondly, there may be irreversible damage to blood vessels or irreversible side effects of drugs. Finally, there is some suspicion, particularly with cholesterol lowering interventions, that adverse effects
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- Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study
- Steven A Grover, Ilka Lowensteyn, Katja L Esrey, Yvonne Steinert, Lawrence Joseph, and Michal Abrahamowicz
BMJ 1995 310: 975-978.[Abstract] [Full Text]
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