Summaries for Patients |

Using Nontraditional Risk Factors to Estimate Risk for Coronary Heart Disease FREE

[+] Article, Author, and Disclosure Information

The summary below is from the full reports titled “Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment: U.S. Preventive Services Task Force Recommendation Statement,” “C-Reactive Protein as a Risk Factor for Coronary Heart Disease: A Systematic Review and Meta-analyses for the U.S. Preventive Services Task Force,” and “Emerging Risk Factors for Coronary Heart Disease: A Summary of Systematic Reviews Conducted for the U.S. Preventive Services Task Force.” They are in the 6 October 2009 issue of Annals of Internal Medicine (volume 151, pages 474-482, pages 483-495, and pages 496-507). The first report was written by the U.S. Preventive Services Task Force; the second report was written by D.I. Buckley, R. Fu, M. Freeman, K. Rogers, and M. Helfand; and the third report was written by M. Helfand, D.I. Buckley, M. Freeman, R. Fu, K. Rogers, C. Fleming, and L.L. Humphrey.

Ann Intern Med. 2009;151(7):I-38. doi:10.7326/0003-4819-151-7-200910060-00003
Text Size: A A A

Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Coronary heart disease (CHD) involves blockages in the blood vessels that bring blood to the heart. When severe, these blockages can lead to a heart attack. Currently, doctors estimate a patient's risk for CHD by examining traditional risk factors, such as cholesterol levels, diabetes, high blood pressure, smoking status, and age. However, some people who have no traditional risk factors develop CHD, and others who have multiple risk factors do not. Researchers wonder whether adding additional factors would improve the ability to estimate a person's chances of developing disease and more effectively treat them to lower risk. Sometimes doctors call these additional risk factors “nontraditional” risk factors.

Nontraditional risk factors include blood tests to measure white blood cell count and levels of fasting blood sugar, homocysteine, lipoprotein(a), and C-reactive protein. Other nontraditional risk factors include the presence of gum disease, calcium in the heart (measured with electron-beam computed tomography), blockages in the blood vessels in the legs (measured with a test that compares blood pressure in the arms and legs, called the ankle–brachial index), and abnormalities in the blood vessels in the neck (measured with a special ultrasound test that looks at carotid intima–media thickness). These nontraditional risk factors seem to be associated with CHD. However, just because they are associated with the risk for CHD does not mean that knowing them in addition to the traditional risk factors would improve a doctor's ability to predict who will develop CHD or to guide treatment so that patients have better health outcomes.

How did the USPSTF develop these recommendations?

The authors reviewed published studies to identify the benefits and harms of including nontraditional risk factors when estimating patients' risk for CHD.

What did the authors find?

Too few studies have determined the benefits and harms of adding nontraditional risk factors to traditional risk factors when estimating a patient's risk for CHD. To know whether doctors should routinely measure nontraditional risk factors, we need studies that compare the CHD outcomes of patients who did have these factors measured with the outcomes of those who did not.

What does the USPSTF suggest that patients and doctors do?

The USPSTF states that not enough information is available about the benefits and harms of measuring nontraditional risk factors when screening for CHD to recommend for or against using them in addition to traditional risk factors. Doctors should continue to measure traditional risk factors and discuss the uncertainty about the benefits and harms of measuring the nontraditional risk factors with patients.

What are the cautions related to these recommendations?

These recommendations may change as new studies become available.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.