Midlife risk factors hard to shake.

• Position: Cardiovascular Disease

While an individual's risk of heart disease may be low in the next five or 10 years, the lifetime risk still could be very high, according to a study in the New England Journal of Medicine, findings that could have implications for clinical practice and public health policy.

"The current approach to heart disease prevention focuses on only short-term risks, which can give a false sense of security, particularly to individuals in their 40s and 50s," indicates internist Jarett Berry, lead author of the study. "Early life decisions we make can have a significant impact on the rest of our lives--and heart healthy choices are no different. The risk factors we develop in younger and middle ages are going to determine our heart disease risk across our lifetime."

Although physicians long have known that the presence of risk factors was a predictor of heart disease across time, gender, and race. Berry notes that the concept of lifetime risk represents an important change in how individuals and their physicians will approach heart disease risk and prevention. "If we want to reduce cardiovascular disease, we need to prevent the development of risk factors in the first place. What determines your heart disease risk when...