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
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- 1. Nelson MR, Doust JA. Primary prevention of cardiovascular disease: new guidelines, technologies and therapies. Med J Aust 2013; 198: 606-610. <MJA full text>
- 2. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290: 898-904.
- 3. Akosah KO, Schaper A, Cogbill C, Schoenfeld P. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol 2003; 41: 1475-1479.
- 4. Krause RS. Cardiac tests. Computed tomography. Medscape 2013; 9 Dec. http://emedicine.medscape.com/article/811577-overview#aw2aab6b7 (accessed Jan 2014).
- 5. Budoff MJ, Shaw LJ, Liu ST, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 2007; 49: 1860-1870.
- 6. Aroney CN. A suggested paradigm for coronary risk screening in asymptomatic persons — assessment of total coronary atheromatous burden. Heart Lung Circ 2012; 21: 449-454.
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