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To the Editor: Dr Ridker and colleagues¹ have proposed the Reynolds Risk Score as an improvement in cardiovascular risk estimation for women. Several concerns regarding the authors' analysis and interpretation should seriously limit enthusiasm for this tool.

First, the equations were derived from a cohort of women health professionals enrolled in a clinical trial, not a population-based sample. Second, the design of the study included self-report of critically important covariates including weight, diabetes, smoking, and blood pressure. In the case of blood pressure, participants did not report measured blood pressure, only categories of blood pressure (ie, within 10 mm Hg increments). No published validation study has been done for the self-reported covariates in this cohort. Given the imprecise ascertainment, the present study probably underestimates the contribution of conventional risk factors to risk models. Third, the authors use the ATP III risk estimator to predict a composite end point of cardiovascular . . . [Full Text of this Article]

Thomas J. Wang, MD
tjwang@partners.org

Sekar Kathiresan, MD
Massachusetts General Hospital
Boston

Donald M. Lloyd-Jones, MD, ScM
Northwestern University
Chicago, Illinois

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