Abstrait

A Physicia's Template for Coronary Artery Disease Risk Assessment in Sedentary and Active Patients: Integrating Medical Risk, Behavioral Psychology, and the Standard of Care.

Vinay Mehta and Timothy E Paterick

Risk assessment in asymptomatic patients participating in robust physical exercise and sedentary patients is complex given the available conflicting data about the relationship of exercise intensity and sedentary lifestyle to coronary atherosclerosis. Physicians are faced daily with making risk/ benefit safety calculations when evaluating these patient groups. An understanding of human behavioral psychology, statistical risk of adverse cardiovascular events based upon the patient?s personal and family medical history, and comprehensive physical examination are the foundation of medical counseling. In recent times, calcium artery scoring has been extensively advocated by various health care organizations as an initial screening tool. With conflicting new data that casts doubt upon the long-standing belief that robust physical activity and habitual exercise training are associated with a reduction in the burden of coronary calcification or coronary atherosclerosis the job of counseling patients has become even more challenging. Most exercise facilities and equipment have the disclaimer ?Talk to your medical professional before undertaking an exercise regimen/ utilizing this equipment.? Medical ethics and jurisprudence demand that we apply the best available evidence in the literature when advising both asymptomatic active and sedentary patients about the risks/benefits of exercise programs. It is imperative for physicians to have the knowledge base to appropriately risk stratify this cohort of patients as well as utilize the tools available from behavioral psychology to make the advice rendered meaningful, palatable, and effective.