Controlled trial of effect of documented cardiovascular risk scores on prescribing

The purpose of our paper (1) was to identify whether there was
clinical value in having cardiovascular risk scores. We wanted to
identify whether having an integrated single score of macrovascular
cardiovascular risk highlights to the clinician that there may be a
clinical issue that needs addressing, and which influences their
prescribing habits. Our paper suggests this is the case, and that in the
setting of a busy clinic having to assess a multitude of individual risk
factors may result in cardiovascular risk being overlooked. Having
established that an integrated score is useful to the practicing
clinician, the next challenge is to identify an appropriate risk score to
use. Smith and correctly indicate that the New Zealand risk score, and
others based on Framingham, all underestimate the cardiovascular risk in
Diabetes, although data from Tayside (2) indicates this is probably not to
the extent suggested by Haffner et al (3). Also the level of risk chosen
to start treatment is an arbitary cut off and can be adjusted eg to 15%
from 20% if thought desirable. The real answer is define the epidemiology
of cardiovascular risk in diabetes more accurately so that more accurate
tables can be developed.

(1) Hall LML, Jung RT, Leese GP. Controlled trial of effect of
documented cardiovascular risk scores on prescribing. Br Med J
2003;326:251-2.

(2) Evans JM, Wang J, Morris AD. Comparison of cardiovascular risk
between patients with type 2 diabetes and those who had had a myocardial
infarction: cross sectional and cohort studies. Br Med J. 2002;324:939-42.

(3) Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laako M. Mortality
from coronary heart disease in subjects with type 2 diabetes and in
nondiabetic subjects with and without prior myocardial infarction. N Engl
J Med 1998;339:229-34

Competing interests:  
None declared