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November 3, 2004

History of Emerging Vascular Disease Risk Factors—Reply

JAMA. 2004;292(17):2086. doi:10.1001/jama.292.17.2086-c

In Reply: We thank Dr Pilgeram for his comments regarding his groundbreaking mechanistic studies on several nontraditional risk factors for atherosclerosis. However, our review focused on the relevance of screening for and treating these risk factors in populations at risk for vascular disease. Thus, while these data provide a pathophysiologic basis linking nontraditional risk factors with atherogenesis, they do not illuminate their incremental predictive value above and beyond validated risk assessment tools such as the Prospective Cardiovascular Münster Study (PROCAM) score and the Framingham Risk Score. Moreover, the true test of these risk factors will be whether screening for such factors and/or modifying them improves clinical outcomes; studies evaluating this important hypothesis are still ongoing.13

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