Overestimation and underestimation of cardiovascular risk in clinical practice: usefulness of risk estimation charts.

INTRODUCTION Charts for the estimation of cardiovascular risk contribute greatly to clinical decision making in the management of asymptomatic individuals. However, most decisions are taken without consulting the charts. The aim of our study was to record the degree of overestimation or underestimation of cardiovascular risk in everyday clinical practice. METHODS Seven cases of asymptomatic individuals at different levels of cardiovascular risk as a result of different combinations of risk factors (one at very low, one at very high and five at intermediate risk) were presented in random order to 30 doctors who deal with primary prevention consultations in their daily clinical practice. They were asked if hypolipidaemic therapy was needed and their answers were compared with the recommended management of the current European guidelines on prevention using the risk charts of the European Society of Cardiology. RESULTS The mean percentage of agreement was 70%. In the two extreme cases agreement with the guidelines was absolute, but in the intermediate cases it varied widely. Particularly in those cases with cholesterol level 200-240 mg/dl it was just 40%, due either to overestimation or to underestimation of the risk. CONCLUSION In the cases of obviously low or obviously high risk, clinical judgement is in accordance with the guidelines. However, in cases of intermediate risk there is either overestimation of risk with non-indicated prescription of hypolipidaemic treatment, or underestimation of risk with no administration of indicated therapy. The use of risk charts in clinical practice may provide substantial help towards a more objective practice of prevention.