Risk prediction (or crystal ball gazing) for coronary disease.

Abstract

The scientific under-pinning of disease prediction is variable and in many situations scarcely more robust than the soothsayer's crystal ball. In this issue, researchers present data from the PARADIGM Registry (an observational study of ∼3000 apparently healthy middle-aged subjects without diabetes or vascular disease) that seeks to determine how primary care physicians assess cardiovascular risk and make decisions regarding statin therapy in primary prevention.1 The authors claim that this is a ‘real-world’ primary care practice dataset. Regular publications of cholesterol/risk management guidelines continue to generate considerable controversy, with part of this controversy related to the use of new risk calculators.2 However, there remains no doubt that most doctors (and their patients and the editors of the lifestyle magazines they consume) feel this is a worthy cause. In this paper, the treating physician assessed and reported the patient's global cardiovascular risk as either: low, intermediate, or high. Additionally, the physician recorded the choice of risk assessment method, and if applicable, the choice of drug therapy (for lipid or blood pressure management). The researchers used the recorded baseline data to formally calculate the 2008 Framingham Risk Score (FRS)3 for 10-year risk of cardiovascular disease (what they … [↵][1]*Corresponding author. Email: justinzaman{at}nhs.net [1]: #xref-corresp-1-1