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Cardiovascular Risk Stratification, Hemoglobin A1c, and the Tempo of Translation Comment on “Cardiovascular Risk Prediction in Diabetic Men and Women Using Hemoglobin A1c vs Diabetes as a High-Risk Equivalent”

Mark J. Pletcher, MD, MPH
Arch Intern Med. 2011;171(19):1718-1720. doi:10.1001/archinternmed.2011.352.
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Among the difficult decisions facing committees tasked with updating the Adult Treatment Panel III (ATP III) guidelines and other cardiovascular disease (CVD) prevention guidelines later this year is how to update CVD risk stratification strategies. It has been a decade since the ATP III guidelines were released,1 and during that time, the science of CVD risk assessment has undergone major advances. New CVD risk markers have been discovered,2 others such as C-reactive protein and coronary artery calcium have become widely accepted as independent predictors of coronary heart disease events,3,4 new risk equations based on cohorts other than the Framingham Heart Study have emerged to challenge Framingham's long-standing hegemony over CVD risk assessment,5 and a new science based on risk reclassification methods has blossomed under the rationale that it helps clinicians and policy makers decide when “novel” risk markers should be measured.6,7 To fully harness this new research and translate it into better cardiovascular health for the US population will require guideline committees to make decisions about specific risk markers, approve 1 or more specific new risk stratification algorithms for clinical use, and set into place a process whereby new knowledge about cardiovascular risk assessment can be vetted and translated into clinician-friendly decision-making tools.

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