David Goff, MD, PhD
Potential Conflicts of Interest: Dr. Goff has served within the past year (no longer active) as a member of the Operations Committee for a clinical trial of a glucose-lowering medication marketed by Merck & Co. and currently serves as a member of a data and safety monitoring board for a clinical trial of a glucose-lowering medication marketed by Takeda.
Goff D. Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment: Clinical Utility in Primary Care. Ann Intern Med. 2012;157:148. doi: 10.7326/0003-4819-157-2-201207170-00018
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Published: Ann Intern Med. 2012;157(2):148.
TO THE EDITOR:
I read the article by Qureshi and colleagues (1) with concern. Whereas the clinical trial methodology is admirable, the scientific questions are not helpful to understanding the role of data on family history in improving risk assessment. On a superficial level, the idea that risk can only be upgraded is incorrect. If a positive family history is used to upgrade risk, a negative family history should be used to downgrade risk. Otherwise, the calibration of the underlying model is ignored.
On a more substantive level, this study provides no evidence on whether data on family history provide value by improving model discrimination or calibration, or whether any reclassification is actually correct. As noted by Qureshi and colleagues, this study also does not address patient behaviors, treatments, or outcomes. The results do not support incorporation of family history assessment into routine clinical practice. We need results documenting improved discrimination, calibration, and correct reclassification. Easy math is not necessarily correct.
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