Age and Time Need Not and Should Not Be Eliminated From the Coronary Risk Prediction Models

Abstract

Risk assessment, risk communication, and risk management are 3 fundamental steps in the primary and secondary prevention of coronary heart disease (CHD). Consequently, national and international guidelines1–4 have been formulated to assist clinicians in providing standardized care for treating coronary risk factors. These guidelines are consistent with the best available scientific evidence on risks of developing CHD and potential strategies to reduce those risks via nonpharmacological and pharmacological interventions. One of the critical concepts on which contemporary guidelines are founded is the notion that the choice and intensity of an intervention strategy should in part be based on the underlying risk—ie, the absolute risk of experiencing a CHD event during a short-term period. This is typically estimated as the 10-year risk of CHD for a man or a woman of a specific age.1,3,4 In this issue of Circulation , Ridker and Cook5 present an argument to eliminate both the age and the time dependency of CHD risk prediction algorithms. On the basis of the objectives of current guidelines and risk prediction algorithms, we disagree with the suggestion made by Ridker and Cook. We submit that not only is removal of age and time from the risk prediction equations not necessary, but, to the contrary, such removal may be inappropriate. Furthermore, as we demonstrate below, the objectives desired by Ridker and Cook are already available with the existing prediction algorithms and often have been incorporated into the standard use of the current guidelines. See p 657 Before we proceed, it would be useful to summarize the observations made by Ridker and Cook. First, they point out the possibility that young individuals with multiple risk factors and very low short-term CHD risk but a much higher lifetime CHD risk (patient example 1 in their article) may not be targeted …