AIM: Informing patients of coronary risk improves outcomes

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Global coronary heart disease (CHD) risk information seems to improve the accuracy of risk perception and may increase intent to initiate CHD prevention among individuals at moderate to high risk, according to a systematic review published in the Feb. 8 issue of Archives of Internal Medicine.

According to the authors, global CHD risk estimation (i.e., a quantitative estimate of a patient's chances of CHD calculated by combining risk factors in an empirical equation) is recommended as a starting point for primary prevention efforts in all U.S. adults. However, lead author Stacey L. Sheridan, MD, from the division of general medicine and clinical epidemiology at the University of North Carolina in Chapel Hill, and colleagues wrote that it is "currently unknown" whether the global CHD risk estimation improves outcomes.

To assess the effect of providing global CHD risk information to adults, the researchers performed a systematic evidence review, searching MEDLINE for the years 1980 to 2008, Psych Info, CINAHL and the Cochrane Database, and including English-language articles that met pre-specified inclusion criteria. Two reviewers independently reviewed titles, abstracts and articles for inclusion and assessed study quality.

The investigators identified 20 articles, reporting on 18 unique "fair" or "good" quality studies (including 14 randomized controlled studies).

Sheridan and colleagues found that global CHD risk information alone or with accompanying education increased the accuracy of perceived risk and probably increased intent to start therapy. They also noted that studies with repeated risk information or risk information plus repeated doses of counseling showed small significant reductions in predicted CHD risk (absolute differences, –0.2 percent to –2 percent over 10 years in studies using risk estimates derived from Framingham equations).

Studies providing global risk information at only one point in time seemed ineffective, according to the researchers.

While the authors concluded that providing coronary risk to adults is effective overall, they wrote that the “effect of global risk presentation on more distal outcomes is less clear and seems to be related to the intensity of accompanying interventions.”