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Methods to identify increased risk of coronary disease in the general population

Editor—Assmann et al have misunderstood the pragmatic question our study answered. In the United Kingdom treatment decisions for the primary prevention of cardiovascular disease are based on the Framingham 10 year coronary risk equation.1 Measuring the cholesterol of the entire population is not currently recommended.1 Given that the NHS has a finite budget we asked how general practitioners can target cholesterol measurement, and hence accurate risk assessment, to those people most likely to benefit from drug treatment to reduce their chance of a stroke or heart attack. 
 
We chose to combine the results of our analyses for men and women because, despite sex differences in risk, the optimum age cut-off point to maximise both sensitivity and specificity is similar for both sexes. Our strategy of screening everyone over the age of 50 identified 91% of men and 98% of women at 15% or more 10 year coronary risk. 
 
Finally, Assmann et al are concerned about people under 50 being neglected because they are not offered a cholesterol test. Although a clinician may not measure cholesterol routinely, this does not imply that they ignore other important risk factors, such as smoking, obesity, and raised blood pressure. 
 
Our study has shown that routine cholesterol measurement, and hence accurate risk assessment, in everyone aged 50 and over is a simple and efficient method of identifying people at high risk of coronary disease in the general population.