Cholesterol confusion in primary prevention of coronary artery disease

Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study

OBJECTIVE

To evaluate the ability of doctors in primary care to assess risk patients' risk of coronary heart disease.

DESIGN

Questionnaire survey.

SETTING

Continuing medical education meetings, Ontario and Quebec, Canada.

SUBJECTS

Community based doctors who agreed to enroll in the coronary health assessment study.

MAIN OUTCOME MEASURE

Ratings of coronary risk factors and estimates by doctors of relative and absolute coronary risk of two hypothetical patients and the "average" 40 year old Canadian man and 70 year old Canadian woman.

RESULTS

253 doctors answered the questionnaire. For 30 year olds the doctors rated cigarette smoking as the most important risk factor and raised serum triglyceride concentrations as the least important; for 70 year old patients they rated diabetes as the most important risk factor and raised serum triglyceride concentrations as the least important. They rated each individual risk factor as significantly less important for 70 year olds than for 30 year olds (all risk factors, P < 0.001). They showed a strong understanding of the relative importance of specific risk factors, and most were confident in their ability to estimate coronary risk. While doctors accurately estimated the relative risk of a specific patient (compared with the average adult) they systematically overestimated the absolute baseline risk of developing coronary disease and the risk reductions associated with specific interventions.

CONCLUSIONS

Despite guidelines on targeting patients at high risk of coronary disease accurate assessment of coronary risk remains difficult for many doctors. Additional strategies must be developed to help doctors to assess better their patients' coronary risk.