Cholesterol and Coronary Heart Disease: The Importance of Patient-Specific Attributable Risk

doi:10.1001/archinte.1988.00380100099021

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Vol. 148 No. 10, October 1988

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Cholesterol and Coronary Heart Disease

The Importance of Patient-Specific Attributable Risk

David J. Malenka, MD; John A. Baron, MD

Arch Intern Med. 1988;148(10):2247-2252.

Abstract

• The value of treating hypercholesterolemia remains controversialdespite extensive investigation, in part because of the researchorientation of much of the relevant literature. Most publishedstudies report relative measures of risks such as the risk ratio.However, clinicians are concerned with the magnitude of risk,or attributable risk, the difference in risk in those with highestand lowest serum cholesterol levels. Since maximum risk modificationis rarely achieved, the attributable risk often overstates thepotential benefit of risk factor reduction. A variant of theattributable risk, the practical attributable risk, gives amore realistic estimate of potential benefit. Since clinicianstreat individuals and not populations, these measures of riskare most useful if reported for subgroups of patients (eg, menand women, as well as those of varying age). To illustrate theseconcepts, we review the literature on hypercholesterolemia,report the risk ratio, attributable risk, and practical attributablerisk for important patient populations, and discuss the implicationsfor clinical practice.

(Arch Intern Med 1988;148:2247-2252)

Author Affiliations

From the Departments of Medicine (Drs Malenka and Baron), Dartmouth-Hitchock Medical Center, Hanover, NH, and White River Junction (Vt) Veterans Administration Medical Center (Dr Malenka).

Footnotes

Accepted for publication April 28, 1988.

Reprint requests to Department of Community and Family Medicine,Dartmouth Medical School, Hanover, NH 03756 (Dr Malenka).

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