We’re all aware that patients with more than two cardiovascular risk factors should have their 10-year risk of coronary disease estimated with the Framingham Risk score. If that score is >20%, the patient’s LDL goal is <100 mg/dL. A few variables, such as total cholesterol, HDL, and systolic BP, can fluctuate. If the patient’s fluctuating risk factors improve, would the LDL goal go back up to 130? Or does a single Framingham Risk score >20% permanently establish the LDL goal at 100?—John S. Rajapakse, MD, Woodbridge, N.J.

I would think that if the improvements occur after treatment, one should stick with the original risk score, but if the improvement is a result of non-risk factor modification efforts (i.e., “natural” variations), then one could recalculate the risk score. Does it really matter? Not if you assume the worse score is the “real” score and act accordingly.—Peter F. Cohn, MD (137-12)

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