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January 21, 2004

Traditional Risk Factors for Coronary Heart Disease

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(3):299. doi:10.1001/jama.291.3.299-b

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.

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