On the Clinical Relevance of the Cardiovascular History

According to Samuel Johnson, “It is as foolish to make experiments on the constancy of a friend as on the chastity of a wife.” Despite this sage admonition, Cheng et al challenge the fidelity of traditional algorithms for estimation of cardiovascular risk based on the quality of symptoms suspicious of angina, asserting that they seriously overstate the actual prevalence of disease.1 They base their conclusion on a study of some 14 000 patients referred for clinically indicated noninvasive coronary computed tomographic angiography (CCTA) and enrolled in Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (CONFIRM). Symptoms were elicited largely through a self-administered patient questionnaire and categorized in a manner similar (but not identical) to that used in a number of cardiovascular guidelines.2,3