Author + information
- Jeffrey S. Berger, MD, MS⁎ (, )
- Courtney O. Jordan, MD,
- Donald Lloyd-Jones, MD, SCM and
- Roger S. Blumenthal, MD
- ↵⁎New York University School of Medicine, 530 First Avenue, SKR-9R, New York, New York 10016
We thank Dr. Stern for his interest in our paper (1), and agree about the difficult clinical challenge facing physicians in cardiovascular prevention. How does one deal with seemingly discordant risk scores in the clinical decision making process? Because the goal of providers is to prevent or postpone the occurrence of disease, understanding a patient's risk of disease is essential. Nevertheless, risk estimation is a probabilistic exercise rather than a definitive answer and therefore will always have some uncertainty, even if we rely on a single “gold-standard” risk equation. However, there are a variety of risk scores that incorporate different end points over different periods of time. The patient in the vignette has an estimated risk as low as 1% for a 10-year fatal atherosclerotic event, but as high as 39% for a lifetime cardiovascular risk. Although this patient's short-term risk may be low, the patient's lifetime risk is quite high and thus should be treated accordingly. Additionally, this woman could be categorized as having the metabolic syndrome with all 5 inclusion criteria: obesity, elevated triglycerides, low high-density lipoprotein, elevated blood pressure, and abnormal fasting glucose (2).
The first goal for this patient would be lifestyle modification with an increase in physical activity and nutrition counseling. If the lifestyle interventions are not sufficient to reduce her markers of increased risk, it would be reasonable to consider starting her on an angiotensin-converting enzyme inhibitor and statin, with the goal of preventing a first cardiovascular event and overt diabetes (3,4).
- American College of Cardiology Foundation
- Berger J.S.,
- Jordan C.O.,
- Lloyd-Jones D.,
- Blumenthal R.S.
- Grundy S.M.,
- Brewer H.B. Jr..,
- Cleeman J.I.,
- Smith S.C. Jr..,
- Lenfant C.,
- American Heart Association, National Heart, Lung, and Blood Institute
- Turnbull F.,
- Neal B.,
- Algert C.,
- et al.,
- Blood Pressure Lowering Trialists' Collaboration