Letters

Predicting risk of death from cardiovascular disease

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7319.999/a (Published 27 October 2001) Cite this as: BMJ 2001;323:999

Which measurements are the most appropriate?

  1. Michael J White, general practitioner (m.j.white@doctors.org.uk)
  1. Stakes Lodge Surgery, Waterlooville PO7 8NS
  2. Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, 00029 HUS, Helsinki, Finland
  3. Department of Medicine, Blenkingesjukhuset, 3748 Karlshamn, Sweden
  4. Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  5. Service de Pharmacologie Clinique, Faculté RTH Laennec, BP 8071-69376, Lyons cedex 08, France
  6. Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, UZ Gasthuisberg, B-3000 Leuven, Belgium

    EDITOR—I would like to predict the risk score for all patients in my practice aged 35 years or older as so clearly described in the article by Pocock et al.1 My enthusiasm invariably turns to disappointment when using risk scores because of the following six factors.

    Age—Most of these studies stop at the age of 74. As a significant proportion of my patients are aged 75 and over, I feel cheated. Is there any possibility of extrapolating the risk scores to an older age?

    Smoking—Should I include former cigarette smokers who have only recently stopped smoking; recent being, for example, during the past year?

    Blood pressure—Which measurement do I use? The most recent measurement, the average of the last three measurements, the highest recorded measurement, the average of the three highest recorded measurements, or a measurement with the patient seated, standing, or ambulatory, or the patient's own measurement?

    Cholesterol concentration—Which measurement is the most appropriate? The most recent measurement, the average of the last three measurements, the highest recorded measurement, or the average of the three highest recorded measurements?

    Creatinine concentration—Which measurement is the most appropriate? The most recent measurement, the average of the last three measurements, the highest recorded measurement, or the average of the three highest recorded measurements?

    Left ventricular hypertrophy—How should it be defined? By evidence from echocardiography only, or by evidence from electrocardiography?

    Ideally I would like to be able to …

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