Abstract

The concept of risk factors has become an integral part of clinical assessment and decision making for patients at risk of either a first or a recurrent cardiovascular event. Unfortunately, risk factors are often misinterpreted as either necessary or sufficient causes of disease. Risk factors represent associations, which may or may not be causal. The article, referred to, addresses the conceptual basis for interpreting risk factors by answering a series of pertinent questions as what is a risk factor; how are risk factors categorized; how can an association be interpreted; how are risk factors assessed and identified; how should clinicians interpret risk factors? The authors point out that in assessing a risk factor, one can reasonably conclude the presence or absence of a valid statistical association, having considered the possible roles of chance, bias and confounding as alternative explanations. Another important issue is that in making judgment about a cause and effect relationship, one must consider not only the results of a single study, but all evidences from different studies. Furthermore, criteria that increase belief in causality include strength of association, temporal sequence, dose-response, consistency, biologic plausibility and specificity. The ways of measuring the risk and the clinical and public health meaning of the different estimates are also mentioned in the article.

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Address for correspondence: D-r M. Dyakova, MU Sofia, Public Health Faculty