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A Systematic Review

Stacey L. Sheridan, MD; Anthony J. Viera, MD; Mori J. Krantz, MD; Christa L. Ice, PhD; Lesley E. Steinman, MSW; Karen E. Peters, DrPH; Laurie A. Kopin, MS; Danielle Lungelow, BA; for the Cardiovascular Health Intervention Research and Translation Network Work Group on Global Coronary Heart Disease Risk

Arch Intern Med. 2010;170(3):230-239.

Background  Global coronary heart disease (CHD) risk estimation (ie, a quantitative estimate of a patient's chances of CHD calculated by combining risk factors in an empirical equation) is recommended as a starting point for primary prevention efforts in all US adults. Whether it improves outcomes is currently unknown.

Methods  To assess the effect of providing global CHD risk information to adults, we performed a systematic evidence review. We searched MEDLINE for the years 1980 to 2008, Psych Info, CINAHL, and the Cochrane Database and included English-language articles that met prespecified inclusion criteria. Two reviewers independently reviewed titles, abstracts, and articles for inclusion and assessed study quality.

Results  We identified 20 articles, reporting on 18 unique fair or good quality studies (including 14 randomized controlled studies). These showed that global CHD risk information alone or with accompanying education increased the accuracy of perceived risk and probably increased intent to start therapy. Studies with repeated risk information or risk information and repeated doses of counseling showed small significant reductions in predicted CHD risk (absolute differences, –0.2% to –2% over 10 years in studies using risk estimates derived from Framingham equations). Studies providing global risk information at only 1 point in time seemed ineffective.

Conclusions  Global CHD risk information seems to improve the accuracy of risk perception and may increase intent to initiate CHD prevention among individuals at moderate to high risk. The effect of global risk presentation on more distal outcomes is less clear and seems to be related to the intensity of accompanying interventions.

Author Affiliations: Division of General Medicine and Clinical Epidemiology (Dr Sheridan), Center for Health Promotion and Disease Prevention (Dr Sheridan and Ms Lungelow), and Department of Family Medicine (Dr Viera), University of North Carolina, Chapel Hill; Division of Cardiology, Denver Health Medical Center, Denver, Colorado (Dr Krantz); Department of Pediatrics, West Virginia University, Morgantown (Dr Ice); Health Promotion Research Center, University of Washington, Seattle (Ms Steinman); Division of Health Policy and Administration, University of Illinois, Chicago (Dr Peters); and Department of Community and Preventive Medicine, University of Rochester, Rochester, New York (Ms Kopin).

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