Risk Estimation in 2009

Abstract

The article by Marma et al1 provides further information about the use of lifetime as opposed to short-term risk prediction.2 Previous publications have documented the high lifetime risk of coronary heart disease (CHD) in both men and women.3,4 Very few women and younger adults, both men and women, had high short-term risk, but many are at high long-term risk. The current article also documents that few in the US population are at both low short-term and long-term risk, 26%, whereas two thirds of 82% of those classified as low short-term risk are at high lifetime risk. Furthermore, only 8.4% of men and 14.3% of women are at both low lifetime risk and have optimal risk factor levels.1 Article see p 8 The addition of either obesity or high-density lipoprotein cholesterol to the models that included systolic blood pressure (BP) and diastolic BP, total cholesterol, diabetes, and current smoking did not substantially change the distribution of low and high lifetime cardiovascular disease–predicted risk. This is consistent with observations that the effects of obesity on risk of cardiovascular disease are primarily due to obesity-related diabetes, elevated BP, and low-density lipoprotein (LDL).5 The high lifetime risk, as reported, is not unexpected. Atherosclerosis is the disease of primary interest.6,7 It begins in childhood, and the prevalence increases with age. At older ages, the prevalence of atherosclerosis in both the coronary and other arteries is very high, at least in the US population, especially when compared with countries that have …