New cardiovascular risk determinants do exist and are clinically useful
1 Department of Internal Medicine, VU University Medical Center, PO Box 7057, Amsterdam 1007MB, The Netherlands
2 Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, Amsterdam 1007MB, The Netherlands
Received 13 July 2007; revised 5 November 2007; accepted 12 November 2007.
* Corresponding author. Tel: +31 20 4444307, Fax: +31 20 4444313. E-mail: y.smulders{at}vumc.nl
See page 441 for the editorial comment on this article (doi:10.1093/eurheartj/ehm644)
Can we improve our understanding of cardiovascular disease (CVD) causality and prediction? Intuitively, we can. Recent publications, however, could be misinterpreted as suggesting the opposite. First, the Interheart study, which concluded that nine conventional risk factors explain >90% of premature myocardial infarction, is at risk for being interpreted as saying that other, ‘new’ cardiovascular risk factors can only cause a small remaining fraction of disease of at most 10%. Secondly, papers addressing the predictive value of new risk factors or markers of early CVD risk have concluded that risk prediction does not improve by adding these variables to risk models. In this paper, we will explain that searching for ‘new causes’ of CVD is still highly relevant, and that improvement of risk prediction is often assessed using inappropriate statistical methodology.
Key Words: Cardiovascular disease • Risk factors • Risk estimation • Epidemiology
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