Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic

In reply: We thank Blazak and Greaves1 for their comments on our article.2 In their letter, the authors noted the possible influence of bias from between-group differences in the baseline-reported use of anti-hypertensive and lipid-lowering therapy. We want to highlight that we accounted for these covariables in the ANOVA models for the primary analysis. Nonetheless, we have undertaken further analysis, and this also confirms that the results are consistent regardless of whether anti-hypertensive or lipid-lowering therapy was reported at baseline (Box). We propose that the mechanism for the modest improvement in blood pressure and cholesterol in the intervention arm is the adoption of lifestyle changes, supported by the noted improvement in body mass index and quality of life scores for this group. It is possible that adherence to prescribed medication may have differed between the groups at follow-up, and this remains an important focus of the approach provided by the rapid access chest pain clinic.