Risk Factors, Not Race, Determine Lifetime Heart Risks

I applaud the approach taken by the investigators of this meta-analysis. Many in the field have been troubled by the tendency to use 10-year risk estimates.

Nobody wants to live just 10 years, so it’s important to be able to provide younger patients with a broader picture of lifetime risk. This study does not give us the ability to calculate 20- and 30-year risk, but it does introduce that concept.

It also introduces the intriguing and somewhat novel concept of primordial prevention, that is, preventing the development of risk factors.

The study’s findings that the effects of traditional risk factors are consistent between races and across birth cohorts is not surprising. In fact, they emphasizes the classic risk factor model we’ve talked about all along, and debunks some myths about age, race, and other factors. I think that’s a useful message.

However, although the concept of primordial prevention is intriguing, the findings don’t obviate the need for maintaining a focus on primary prevention. The treatment effects mentioned by the investigators are small, but given the number of patients who get heart disease, they represent an enormous effect.

Paul D. Thompson, M.D., is director of cardiology at Hartford Hospital. He is a consultant, has done research, or has received speaking honoraria numerous manufacturers of lipid-lowering drugs, including GlaxoSmithKline, Merck, Pfizer, and AstraZeneca.