Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: medical office assessment: Writing Group I.

Abstract

Writing Group I of Prevention Conference V reviewed the role of medical office assessment in the detection of risk factors and estimation of total cardiovascular risk. The primary focus was on identification of known risk factors for coronary heart disease (CHD). Population screening may identify risk factors that prompt people to seek clinical consultation. Risk factors may also be identified in patients who are seeking medical treatment for other conditions. Physicians have the responsibility to evaluate cardiovascular risk in all their patients. Medical office assessment permits the identification of many high-risk patients without the need for noninvasive testing for atherosclerotic burden or subclinical myocardial ischemia. Techniques for office assessment available to clinicians include history, physical examination, laboratory testing, and electrocardiography (ECG). Routine evaluation and testing provides most of the information needed to estimate risk and make treatment decisions. The essential information required for estimating risk for CHD lies in the known risk factors for coronary disease. These risk factors must first be identified and their severity determined. The relationship between risk factors and development of CHD is strong but variable. When a risk factor is causally and independently related to disease, the physician should make recommendations to the patient about risk factor modification. When risk factors are associated with increased risk for CHD but are not directly causative, the risk factor is considered to be a marker for increased risk . In the following discussion, the major risk factors and risk markers for CHD that can be detected in medical office assessment are reviewed. The different categories of risk are then considered. Finally, the special characteristics of each risk factor in relation to global risk assessment are reviewed. Special groups, including older patients and those with diabetes, are considered, and suggestions are made for modifying the existing guidelines for risk …