CHD Risk Reduction in Primary Care: A Personalized Approach

Allison Vorderstrasse, DNSc, APRN; Ruth Q. Wolever, PhD; Alex Cho, MD, MBA; Geoffrey S. Ginsburg, MD


June 13, 2013

In This Article

What would happen if primary care providers could offer a patient a personalized, genomic- and clinical-based assessment of the risk for coronary heart disease (CHD) and couple it with integrative health coaching? Would patients be more likely to engage in risk-reduction strategies? We combined our expertise in clinical primary care practice, behavioral research, health coaching, genetics, and genomics to find out.

The Need for a New Approach

Nationally, 6% of adults are living with CHD, and it is one of the leading causes of mortality in the United States.[1] Morbidity and mortality are largely preventable with appropriate medical treatment and health behavior changes, such as diet and exercise, but rates remain high.

The Framingham Risk Score (Figure 1) is one of the most well-validated CHD risk assessment tools. It is designed to calculate 10-year CHD risk using clinical factors, such as blood pressure and lipid levels, that are often addressed during primary care visits.[2]

Figure 1. Framingham Risk Assessment Tool. National Cholesterol Education Program, National Heart, Lung, and Blood Institute.[2]

However, assessment tools such as the Framingham Risk Score are not widely used in primary care practice to guide a comprehensive risk discussion, and on their own, they may not be sufficient to motivate changes in behavior.


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