Providing written information to patients about the risk- reducing benefits of prescribed medications and directing them to reliable sources of information may facilitate shared decision making and increase adherence to prescribed therapies. However, medication nonadherence remains a very difficult problem to address (Haynes et al 2005). The most important single effort in this regard may be to maintain regularly scheduled follow-up, including contacting patients who miss appointments. While providing individualized risk information can promote health, the perception of increased personal risk may also cause anxiety, especially if: (1) the magnitude of the risk is very high; (2) uncertainty regarding the risk is not reduced; (3) no preventive course of action is offered; (4) people feel unable to adhere to advice for preventive actions; or (5) if patients lack social support and coping skills (Pierce et al 2000). These factors should be taken into account before discussing CVD risk with high-risk patients. Options for reducing risk should be clearly presented in a supportive environment that provides continuity of care and ongoing assistance in attaining treatment goals. Evidence for the efficacy of risk communication Personalized risk communication has been associated with risk-reducing behavior. Compared with the presentation of probabilistic information alone (risk expressed in percentages or proportions), the odds of entering cancer and cholesterol screening programs was higher when persons were presented with their categorical risk (ie, high, medium, or low) and when their own personal risk factors were outlined (Edwards et al 2004). The efficacy of commun- icating individualized CVD risk was demonstrated in the Coronary Health Assessment Study (Lowensteyn et al 1998). Participants included 253 community-based physicians randomized into intervention and control groups and 958 of their patients. The intervention group received computer- generated individualized CVD risk profiles and options for risk reduction within 10 days of an initial visit, whereas control patients received this information only if they returned for a 3-month follow-up visit. The intervention group had a significantly higher ratio of high-risk/low-risk patients who returned for a follow-up visit and significantly greater mean reductions in total and LDL-cholesterol and predicted 8-year coronary risk. Another study showed reductions in CHD risk, body mass index, and cholesterol levels at the 5-year follow-up in intervention groups that Vascular Health and Risk Management 2005:1(4) Communicating risk in type 2 diabetes received CHD risk appraisal with or without physician consultation (Engberg et al 2002). Knowledge of patients’ CVD risk status has also been shown to affect physician behavior. When the cardiovascular risk scores of patients with DM were provided to their physicians and were categorized as “low” (< 10%), “moderate” (10% –20%), or “high” (> 20%), physicians were significantly more likely to prescribe blood pressure and lipid-lowering drugs than physicians in a control group who were not provided with risk scores (Hall et al 2003). Using technology to facilitate risk communication The availability of interactive technology presents an incredibly rich opportunity to create individualized CVD risk communications for patients with diabetes. Interactive multimedia presentations can be made mentally and emotionally engaging through the use of video, graphics, animation, sound, and text. The presentation of risk information in this manner has been shown to correct overly optimistic perceptions of personal risk and is likely to promote more involvement in the process of learning when compared with traditional materials (Rothman et al 1999; Strecher et al 1999). Interactive technology may be effective in addressing issues of limited health literacy. Information can be presented in a manner that does not require literacy or mathematical ability for understanding, and an accompanying audio track can provide access to information for patients who are unable to read. Current technology permits full patient interaction with automated presentations with little or no understanding of computer operations. The availability of an interactive computer-based risk communication program should improve access to health information for persons of lower socioeconomic status (SES). Persons of lower SES have limited access to health information, an increased prevalence of diabetes and are more likely to underestimate their health risk compared with persons of higher SES (Avis et al 1989; Kreuter et al 1995; Strecher et al 1999). Access to an individualized interactive risk presentation coupled with physician involvement in discussing its contents should help to bridge this “information gap”. Summary The effective management of CVD risk factors in patients with DM is an extraordinarily complex process. Patients 305