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Adding a life-course perspective to cardiovascular-risk communication


Current practice in the primary prevention of cardiovascular disease (CVD) involves estimation of the short-term (typically 5–10-year) risk of developing CVD. This risk estimation can serve as the prelude to a conversation between physicians and patients about CVD risk and risk-reducing therapies. However, focusing solely on short-term risk directs these conversations towards individuals who, in all likelihood, have already accrued substantial atherosclerosis during their lifetime. We suggest that estimation of lifetime risk and other novel methods of risk communication, such as risk-adjusted age, should be used as an adjunct to 10-year risk estimation. We believe that these strategies will improve patient understanding of CVD risk, identify new sections of the population who might benefit from preventive therapy, and motivate lifestyle changes and adherence to therapy early in the course of disease progression.

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Figure 1: Sex-specific and age-specific population estimates of risk distribution among US adults aged 20–79 years, without diagnosed cardiovascular disease.
Figure 2: Prevalence of a low-risk profile at 20-year follow-up adjusted for age, sex, and ethnicity according to HLFs among participants in the CARDIA study.23


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Both authors researched data for the article, contributed substantially to discussion of its content, and wrote, reviewed, and edited the manuscript before submission.

Corresponding author

Correspondence to Donald M. Lloyd-Jones.

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The authors declare no competing financial interests.

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Karmali, K., Lloyd-Jones, D. Adding a life-course perspective to cardiovascular-risk communication. Nat Rev Cardiol 10, 111–115 (2013).

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