614 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Sirs—In the April issue of the International Journal of

Epidemiology, Hans-Werner Hense provides a comprehensive treatise on the current state of cardiovascular risk assessments.1 He highlights the problems with using risk scores derived from epidemiological data to target preventive treatment at highest risk individuals. His comments add to the growing literature recognizing that the risk assessment methods used in current treatment guidelines do not provide an accurate assessment of an individual’s true risk.2,3 Hense identifies some of these potential sources of inaccuracy: the variation of cardiovascular risk between populations, using predictions based on assessment of risk factors at one occasion only, the confusing variety of endpoints used in different risk scoring methods, and the ‘contamination ’ of risk predictions by risk-reducing treatments such as blood pressure lowering drugs. Hense also highlights the important, but often unrecognized, implication