BMJ 2002;324:1570-1576 ( 29 June )

Education and debate

Risk factor thresholds: their existence under scrutiny

M R Law, professor of preventive medicine, N J Wald, professor and head. 

Wolfson Institute of Preventive Medicine, Department of Environmental and Preventive Medicine, Barts and The London, Queen Mary's School of Medicine and Dentistry, London EC1M 6BQ

Correspondence to: M R Law m.r.law@qmul.ac.uk

The first 150 words of the full text of this article appear below.

Interventions to lower blood pressure, serum cholesterol, and other risk factors reduce the risk of cardiovascular disease regardless of initial levels. It follows, say Malcolm Law and Nicholas Wald, that the goal is not to "normalise" risk factors but to reduce them as much as possible. This means targeting everyone at high risk, as determined by age or known cardiovascular disease rather than by the level of the risk factors

Physiological variables such as blood pressure, serum cholesterol, body mass index, and bone mineral density are important in the aetiology of common diseases. They are not direct environmental causes of disease, like smoking, but they may be seen as biochemical or biophysical variables, under partial genetic control, that are intermediates between environmental factors and disease itself. It is known that risk can be reduced by lowering high levels of these variables by drug treatment or lifestyle change. But there is . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Beyond the risk factors.

Sergio Stagnaro
bmj.com, 28 Jun 2002 [Full text]

But thresholds for treatment do exist..

Leslie S Lewis
bmj.com, 29 Jun 2002 [Full text]

Is The Threshold is £37K Per QALY?

Michael A Soljak
bmj.com, 2 Jul 2002 [Full text]

Risk of lowering risk factors

Gregor Caspari
bmj.com, 2 Jul 2002 [Full text]

what are we trying to prevent

David Rillstone Robertson
bmj.com, 4 Jul 2002 [Full text]

Risk factor modification must be evidence-based

Mark J Garton
bmj.com, 7 Jul 2002 [Full text]

Argument is not supported by the data

Adam Jacobs
bmj.com, 9 Jul 2002 [Full text]

Lives at risk

Dougal J Jeffries, et al.
bmj.com, 11 Jul 2002 [Full text]

Dynamic CHD risk profiling for focused recall

John M. Waddell, et al.
bmj.com, 11 Jul 2002 [Full text]

Pharmacological treatment determined by age alone - a step too far?

Steven M Laitner
bmj.com, 12 Jul 2002 [Full text]

Association does not prove causation and is not the same as a dose-response relation.

Uffe Ravnskov, et al.
bmj.com, 16 Jul 2002 [Full text]

Potentially a very dangerous paper indeed

Malcolm E Kendrick
bmj.com, 18 Jul 2002 [Full text]