Scott M. Grundy

Problems on the Pathway From Risk Assessment to Risk Reduction

Assessment of risk and reduction of risk are well-accepted responsibilities of the physician. The pathway from assessment of risk to reduction of risk basically involves three steps: (1) measurement of risk factors and collection of clinical data relevant to patient risk; (2) interpretation of risk-related data with estimation of risk in absolute terms (eg, risk of an event per year) as well as relative terms (ie, low, intermediate, or high compared with others of the same age and sex); and (3) on the basis of risk estimation results, intervention to minimize disease risk or to prevent risk factor development in the future. Although the process seems reasonably straightforward, problems occur at each step that weaken the link between risk assessment and risk reduction. Such problems occur in assessment of CVD risk estimation and reduction just as in most other areas of medical practice in spite of the availability of excellent data relating to CVD risk estimation from the Framingham Heart Study and other similar data sets.1 nnPeriodic measurement of CVD risk factors in healthy people (step 1) is routinely recommended by the AHA, the ACC, and the NHLBI, in addition to other authorities on disease prevention.2 3 4 Blood lipid measurements, blood pressure readings, age, sex, cigarette smoking and diabetic status, ECG findings, and other risk …