Editor’s Presentation. Secondary prevention: First of all, address the basics

Single time point measurements of traditional cardiovascular risk factors (RFs) show strong associations with future cardiovascular event risk. In line with this concern, a group of researchers from the PROG-IMT consortium has made an interesting observation: average measurements of RFs assessed at separate time points ((RF1–RF2)/2), but not ‘progression’ between the measures (defined as the difference (RF2–RF1)), predict future cardiovascular risk. This observation challenges our traditional practice of risk prediction, and the reasons for it are likely to be multifactorial. First, as indicated by the authors, recent treatment for a RF such as statin has become so potent and widespread in many populations that measured RF tends to reflect more ‘treated’ values, which is likely to weaken its predictive property as compared with ‘non-treated’ values in the past. Second, the second measurement (RF2) may not be so different from the first measurement (RF1) because of a relatively stable lifestyle and/or biological condition over the two time points. This would make the regression to the mean phenomena come into play for the difference (RF2–RF1), leading to a low signal-to-noise ratio. In conclusion, the researchers from the PROG-IMT consortium have raised a very noteworthy and valuable point, that the predictive property of some RFs may have lessened in recent years.