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January 21, 2004

Traditional Risk Factors for Coronary Heart Disease—Reply

Author Affiliations

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

JAMA. 2004;291(3):299. doi:10.1001/jama.291.3.300-b

In Reply: Our data showed that the common belief that only 50% of patients with CHD have at least 1 of the major CHD risk factors (smoking, elevated blood pressure or cholesterol levels, and diabetes) is incorrect. Our goal in reporting these findings was to aid in dispelling the 50% notion, certainly not to replace that myth with any other, as Drs Root and Cobb suggest.

It is well known that the traditional risk factors have a dose-dependent relationship with the risk of CHD.1 Thus, while levels of smoking, blood pressure, and cholesterol in excess of physiologically ideal values do not guarantee that exposed individuals will experience CHD, the lack of specificity of the risk factors in producing CHD should not necessarily lead to the conclusion that there are "still large gaps in the understanding of the causes" of CHD.

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