Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Greenland and colleagues1 attempted to dispel the myth that only 50% of patients
with CHD have any of the 4 conventional risk factors. We fear, however, they
may have replaced it with another myth that 90% have such risk factors. While
this may be strictly correct, both studies understated the high prevalence
of the same risk factors among patients who did not die of CHD. From the data
in Table 1 of the article by Greenland et al, we compute that the "1 or more
risk-factors" rule is 88% sensitive but only 33% specific. In other words,
while 88% of patients who died from heart disease had 1 or more risk factors,
67% of those who did not die of heart disease also had 1 or more risk factors.
Root M, Cobb F. Traditional Risk Factors for Coronary Heart Disease. JAMA. 2004;291(3):299. doi:10.1001/jama.291.3.299-b