Roach and Marrero must be motivated to implement appropriate lifestyle changes, appropriately self-manage a number of chronic conditions, and adhere to recommendations for therapy and follow-up. The successful attainment of treatment goals for modifiable CVD risk factors requires multidisciplinary intervention with consideration given to multiple patient, physician, phamacologic, and environmental factors. Effective CVD risk communication is merely one component of a comprehensive risk management effort, but it plays a central role in the counseling of patients with DM for whom primary prevention of CVD is the most favorable outcome. There is evidence that improved patient–physician communication about CVD risk and risk reduction strategies can activate both parties toward the intensification of therapies directed at CVD risk factors. Individualized risk calculation can be readily perfomed during outpatient visits using risk calculation software, and the resulting information can be effectively commnicated to patients using the approaches outlined above. The risk message must be presented such that patients understand the potentially serious consequences of a CVD event and that they are personally at risk for such an event. Finally, patients must be given information about options to reduce their CVD risk. The risk message should be delivered in conjuction with a clinical encounter with the healthcare provider so that questions and concerns can be addressed, and shared decision making can begin. Physicians need not try to achieve this entire set of communication goals in a single visit. In fact, risk communication can and should build upon itself over time and become an integral part of the patient–physician interaction at each clinic visit. The availability of interactive computer technology holds great promise for risk communication. Vivid and engaging risk messages can be created, and the presentation can be tailored to individuals of low health literacy. Computer-based programs may increase the effectiveness and efficiency of risk communication in that little effort is required of medical personnel, and patients enter the clinical encounter with basic information, obviating the need for the physician to create the entire risk discussion de novo. As technologies become more widely available and accessible to individuals across the socioeconomic spectrum, physicians may be able to provide patients with a portable, interactive individualized risk presentation in the form of a compact disc that can be viewed on the patient’s own playback device, and patients may be able to access this information in their homes via the Internet. Even if physicians do not have access to computer-based resources, the risk communication principles outlined above can be applied to the creation of simple but vivid print materials that can be constructed in template form and that incorporate individual patient-based risk information to be used during the clinical encounter. While the construction of this risk communication “tool kit” will require time and effort, its availability should increase the efficiency of patient counseling for the reduction of CVD risk, especially if materials can be prepared and compiled by office personnel and viewed by the patient prior to the patient–physician encounter. Further research is needed to optimize risk com- munication and to incorporate these methods into clinical practice. The strategies described above for communicating risk, while based in a theoretical background, are offered with some caution given the limited amount of data regarding the optimal methods for constructing the risk message and the paucity of data regarding the efficacy of risk communication in altering health-related behavior. A common and important limitation of studies to date is the omission of the contextual information necessary for individuals to fully understand, internalize, and act on risk information. In addition, studies of the specific effect of CVD risk communication to patients with diabetes have not been performed. Therefore, future research should focus on how to most effectively correct underestimates of risk on the part of patients and physicians, how to most effectively communicate probabilistic information to illustrate magnitude of risk, how to provide a meaningful context for risk information, and most importantly, how risk communication affects clinical outcomes, namely the incidence of cardiovascular events. The availability of modern interactive computer technology and the powerful effect of multimedia presentations demand that the efficacy and feasibility of this mode of risk communication be evaluated via translational research studies in real-world settings. At present, providers of care to persons with diabetes should utilize all available resources including the principles of risk communication outlined above, the services of other health professionals including diabetes educators and dietitians, and reliable web-based material to facilitate the communication of health information to patients. Healthcare providers should use the clinical encounter as an opportunity to foster patient empowerment and shared decision making, employing risk communication as one of many critically important tools in this process. Through this effort, patients 306 Vascular Health and Risk Management 2005:1(4)