Docs Drop the Ball on Risk Assessment

Despite pleas from medical experts and professional societies to the contrary, doctors are still generally terrible in assessing their patients' risk of developing coronary artery disease. It is important to detect this risk when it exists, because in up to 30% of patients with coronary disease, the first symptom is either a heart attack or sudden death.

It appears that many doctors are still in the "leave it to my intuition" phase of their professional development when it comes to risk screening - that is, while numerous and readily-available tools exist to allow docs to do rapid risk screening, many show little willingness to use these tools. As a result, instead of directing their efforts toward those patients whose risk for coronary disease is relatively high, they often end up often ignoring patients whose risk is high, and doing expensive studies on patients whose risk is low.

Using some simple screening measures, it is actually quite easy to categorize a patient's risk into one of three categories: low, intermediate, or high.

Low risk patients can be managed without any further intervention, except for routine coaching on maintaining a healthy lifestyle. About 35% of U.S. adults fall into this category.

High risk patients should immediately be placed on appropriate treatments proven to reduce the risk of heart attack and death, such as statin drugs, beta blockers, aspirin, and/or ACE inhibitors. About 25% of U.S. adults are in this category. Intermediate risk patients should have non-invasive tests to measure whether or not they already have evidence of coronary artery disease, such as stress/thallium testing or electron beam tomography (EECP.) Roughly 40% of U.S. adults are in the intermediate risk category.

Which category are you in?

The good part of all this is that you don't need to wait for your doctor to think of assessing your risk. You can do it yourself if you have the appropriate baseline information. Here's what you need to know: 

• whether you smoke or not
• your total and HDL cholesterol levels
• your blood pressure
• whether you have evidence of diabetes
• whether you are overweight for your age and height
• your family history

With this information, here's what puts you into the low risk category:

• nonsmoker
• total cholesterol < 200 mg.dL, HDL cholesterol > 40 mg/dL
• systolic BP < 120, diastolic BP < 80
• no evidence of diabetes
• not overweight
• no family history of premature vascular disease

You are in the high risk category if you have any of the following:

• known coronary artery disease or other vascular disease
• type 2 diabetes
• over 65 with multiple risk factors

And you are in the intermediate risk group if you don't fit into either the low or high risk groups.

Click here for several on-line risk assessment utilities that can give you an even more accurate idea of your risk.

By the way, doing simple risk assessment is one of the most important basic jobs of the physician. The failure to do such risk assessment can be fairly considered evidence that your doctor is doing sub-standard work. Many of the things doctors need to think about are complicated - this one isn't. DrRich, for one, wouldn't stick with a doc who isn't even doing the simple things right.