Potential use of 10-year and lifetime coronary risk information for preventive cardiology prescribing decisions: a primary care physician survey

Arch Intern Med. 2010 Mar 8;170(5):470-7. doi: 10.1001/archinternmed.2009.525.


Background: Data are sparse regarding how physicians use coronary risk information for prescribing decisions.

Methods: We presented 5 primary prevention scenarios to primary care physicians affiliated with an academic center and surveyed their responses after they were provided with (1) patient risk factor information, (2) 10-year estimated coronary disease risk information, and (3) 10-year and lifetime risk estimates. We asked about aspirin prescribing, lipid testing, and lipid-lowering drug prescribing.

Results: Of 202 physicians surveyed, 99 (49%) responded. The physicians made guideline-concordant aspirin decisions 51% to 91% of the time using risk factor information alone. Providing 10-year risk estimates increased concordant aspirin prescribing when the 10-year coronary risk was moderately high (15%) and decreased guideline-discordant prescribing when the 10-year risk was low (2 of 4 cases). Providing the lifetime risk information sometimes increased guideline-discordant aspirin prescribing. The physicians selected guideline-concordant thresholds for initiating treatment with lipid-lowering drugs 44% to 75% of the time using risk factor information alone. Selecting too low or too high low-density lipoprotein cholesterol thresholds was common. Ten-year risk information improved concordance when the 10-year risk was moderately high. Providing lifetime risk information increased willingness to initiate pharmacotherapy at low-density lipoprotein cholesterol levels that were lower than those recommended by guidelines when the 10-year risk was low but the lifetime risk was high.

Conclusions: Providing 10-year coronary risk information improved some hypothetical aspirin-prescribing decisions and improved lipid management when the short-term risk was moderately high. High lifetime risk sometimes led to more intensive prescription of aspirin or lipid-lowering medication. This outcome suggests that, to maximize the benefits of risk-calculating tools, specific guideline recommendations should be provided along with risk estimates.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anticholesteremic Agents / administration & dosage*
  • Aspirin / administration & dosage*
  • Cardiology / methods
  • Cardiology / standards
  • Coronary Disease / prevention & control*
  • Decision Support Techniques
  • Drug Prescriptions / statistics & numerical data
  • Family Practice / methods
  • Family Practice / statistics & numerical data*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Guideline Adherence / statistics & numerical data
  • Health Care Surveys
  • Humans
  • Internal Medicine / methods
  • Internal Medicine / statistics & numerical data*
  • Lipids / blood*
  • Male
  • Middle Aged
  • Physicians, Family / statistics & numerical data*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prescriptions / statistics & numerical data*
  • Primary Prevention* / methods
  • Primary Prevention* / standards
  • Primary Prevention* / statistics & numerical data
  • Risk Factors
  • Surveys and Questionnaires


  • Anticholesteremic Agents
  • Fibrinolytic Agents
  • Lipids
  • Aspirin