Here’s a sobering realization: No matter how well I take care of my patients, all of them—that’s right, all of them—are going to die someday. This pessimistic thought came to me this week as I was reviewing some of the recent cardiac-risk calculators.
These tools, many of which were based on a landmark observational research program in Framingham, Mass., allow physicians to estimate an individual’s risk of cardiac death over the next 10 years, or over a lifetime. Surprisingly few variables count in this calculation: age, gender, smoking history, blood pressure, presence of diabetes, and cholesterol level.
This information is incredibly important: It lets physicians and patients identify a risk before it becomes a reality. The whole concept of preventing cardiac disease stems from identifying apparently healthy people at risk. At the same time, I’ve talked with people (patients and friends) who don’t like thinking about it.
It’s not comfortable to plug in your numbers and find out you’ve got a 10% risk of dying from heart disease. At the very least, it ruins your appetite for that steak you were planning to have for dinner. To make matters worse, you can find risk calculators for breast cancer, lung cancer—you name it. You might be tempted to add up the risks (which isn’t the way the calculators were intended to be used ), cancel your next doctor’s appointment, and start planning your funeral instead.
But a recent study by researchers at the National Cancer Institute might help clarify things. Instead of addressing individual diseases, this study tackles several at once: heart disease, stroke, six kinds of cancer, pneumonia, influenza, AIDS, chronic lung disease, accidents, and a sum of all possible causes.
In the study, only age, gender, and smoking status were used to calculate risk. By combining diseases this way, you get a sense of what someone of your age and gender is at highest risk for. Smokers can glimpse what they would gain if they quit. Perhaps you’ve been unnecessarily worrying about cancer, when it’s really heart disease that should be on your radar. In that case, the data from the Framingham study points to things you can actually do to prevent heart disease—such as lowering your cholesterol, treating blood pressure, and quitting smoking.
So while it’s true that all my patients will die of something, I find these risk calculators very helpful. I certainly don’t feel powerless in trying to change the odds, and to help them buy back a little bit more of that precious resource: time.
(PHOTO: FOTOLIA/HEALTH)
Recent posts by Dena Rifkin, MD:
