Primary prevention of cardiovascular disease: new guidelines, technologies and therapies

To the Editor: In relying exclusively on traditional risk factors, Nelson and Doust have failed to provide an effective method of screening the asymptomatic individual for cardiovascular risk.1 Much of the population-attributable risk for myocardial infarction is related to these risk factors, but their specificity is very low because of their high prevalence in people who will never develop the disease. Like the general population, most individuals with coronary heart disease have one or no conventional risk factors.2