title: Treatment of patients with intermediate cardiovascular risk: Are clinical measures enough?
abstract: OBJECTIVE
  Clinical measures of cardiovascular disease risk (CVD) are important tools for establishing therapy to lower CVD risk. Risk assessment has come under criticism because clinical measures can underestimate or overestimate CVD risk. We assessed CVD risk in 252 subjects without evidence of CVD to establish therapy of one or more risk factors from clinical indications. The subjects all had intermediate CVD risk using the Framingham score.
  
  
  RESULTS
  Average age was 59.1 years. 23.8% were smokers, 59.1% were hypertensive, 65.1% had hyperlipidemia. BMI was greater than 30 kg/M(2) in 56% and diabetes was present in 43.7%. In this cohort, 86.9% required therapy for hypertension or hyperlipidemia, and this proportion increased to 95.6% when subjects with diabetes were included. Of the remaining 4.4% (11 subjects), 7 reached intermediate risk based on cigarette smoking and 4 based on age >65 years old. Among diabetics, 94/110 had another risk factor and would require statin and ACE or ARB therapy.
  
  
  CONCLUSIONS
  Of subjects at intermediate risk for CVD, 98.4% would not require further testing to decide on therapy to lower CVD risk. Although 16 diabetic subjects had no other risk factors, current guidelines suggest that these subjects should be treated to reduce CVD risk.
authors.affiliation: Cardiology Section, Temple University Medical Center, Philadelphia, PA 19140, USA. Alfred.bove@tuhs.temple.edu
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Bove
authors.forename: William P
authors.initials: WP
authors.lastname: Santamore
authors.forename: Carol
authors.initials: C
authors.lastname: Homko
authors.forename: Abul
authors.initials: A
authors.lastname: Kashem
authors.forename: Robert
authors.initials: R
authors.lastname: Cross
authors.forename: Timothy R
authors.initials: TR
authors.lastname: McConnell
authors.forename: Gail
authors.initials: G
authors.lastname: Shirk
authors.forename: Francis
authors.initials: F
authors.lastname: Menapace
mesh_terms: D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D018579:Patient Selection; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome