There is uncertainty whether current strategies for providing CVD risk scores  affect CVD events .
Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm .
BACKGROUND The current paradigm for cardiovascular disease ( CVD ) emphasises absolute risk assessment to guide treatment decisions in primary prevention .
Although the derivation and validation of multivariable risk assessment tools , or CVD risk scores , have attracted considerable attention , their effect on clinical outcomes is uncertain .
OBJECTIVES To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes , risk factor levels , preventive medication prescribing , and health behaviours .
A Randomized Trial of Peer Coach and Office Staff Support to Reduce Coronary Heart Disease Risk in African-Americans with Uncontrolled Hypertension
OBJECTIVE Adopting features of the Chronic Care Model may reduce coronary heart disease risk and blood pressure in vulnerable population s. We evaluated a peer and practice team intervention on reduction in 4-year coronary heart disease risk and systolic blood pressure . DESIGN AND SUBJECTSA single blind , r and omized , controlled trial in two adjacent urban university-affiliated primary care practice s. Two hundred eighty African-American subjects aged 40 to 75 with uncontrolled hypertension . INTERVENTIONThree monthly calls from trained peer patients with well-controlled hypertension and , on alternate months , two practice staff visits to review a personalized 4-year heart disease risk calculator and slide shows about heart disease risks . All subjects received usual physician care and brochures about healthy cooking and heart disease . MAIN MEASURES Change in 4-year coronary heart disease risk ( primary ) and change in systolic blood pressure , both assessed at 6 months . KEY RESULTS At baseline , the 136 intervention and 144 control subjects ’ mean 4-year coronary heart disease risk did not differ ( intervention = 5.8 % and control = 6.4 % , P = 0.39 ) , and their mean systolic blood pressure was the same ( 140.5 mmHg , p = 0.83 ) . Endpoint data for coronary heart disease were obtained for 69 % of intervention and 82 % of control subjects . After multiple imputation for missing endpoint data , the reduction in risk among all 280 subjects favored the intervention , but was not statistically significant ( difference −0.73 % , 95 % confidence interval : -1.54 % to 0.09 % , p = 0.08 ) . Among the 247 subjects with a systolic blood pressure endpoint ( 85 % of intervention and 91 % of control subjects ) , more intervention than control subjects achieved a > 5 mmHg reduction ( 61 % versus 45 % , respectively , p = 0.01 ) . After multiple imputation , the absolute reduction in systolic blood pressure was also greater for the intervention group ( difference −6.47 mmHg , 95 % confidence interval : −10.69 to −2.25 , P = 0.003 ) . One patient died in each study arm . CONCLUSIONS Peer patient and office-based behavioral support for African-American patients with uncontrolled hypertension did not result in a significantly greater reduction in coronary heart disease risk but did significantly reduce systolic blood pressure
There is uncertainty whether current strategies for providing CVD risk scores  affect CVD events .
Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm .
BACKGROUND The current paradigm for cardiovascular disease ( CVD ) emphasises absolute risk assessment to guide treatment decisions in primary prevention .
Although the derivation and validation of multivariable risk assessment tools , or CVD risk scores , have attracted considerable attention , their effect on clinical outcomes is uncertain .
OBJECTIVES To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes , risk factor levels , preventive medication prescribing , and health behaviours .