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International Journal of Epidemiology 2002;31:822-824
© International Epidemiological Association 2002

Cardiovascular Disease

Commentary: The prediction of coronary heart disease risk in individuals— an imprecise science

Peter Brindle and Margaret May

Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.

The first 10% of the full text of this article appears below.

The paper by Thomsen and colleagues1 tells us that we should be cautious about applying a clinical decision rule developed in one population to another without first assessing its accuracy in that population. Unfortunately in the case of coronary risk prediction that is what has already happened. Coronary risk prediction using multiple risk factors has evolved as a method of helping clinicians prioritize prevention measures in patients who do not yet have overt cardiovascular disease. In the case of statins, restricting treatment to those individuals above an arbitrary level of risk, say 3% annual coronary heart disease (CHD) risk,2 has also provided a mechanism of limiting the costs of treating all those who might benefit (annual CHD risk >=0.6%) according to trial evidence.3 . . . [Full Text of this Article]


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