7th December 1997

...press return to predict your death

Jenny McCartney feeds her details into a computer and awaits its verdict. Fortunately for her, she is not a 59-year-old smoker who loves fried eggs and potatoes.

On a sunlit summer evening I asked a computer how likely I am to die from a heart attack in the next 10 years. And it told me. British doctors have created the first computer program in the world that can, it is claimed, predict - with 95 per cent accuracy - the chances of any individual dying from a heart attack or stroke in the next decade.

That very idea might be enough to strike fear into any middle-aged man with a fondness for cigarettes and fried potatoes. But the results could also save him from death within a decade, by showing him how changing his behaviour can quickly and dramatically reduce his risk.

Professor John Martin, who holds the British Heart Foundation chair at University College London Hospital, developed the program with his colleague Professor Patrick Vallance.

Its predictions compare the individual's risk with the average for someone of the same age and sex, based on 30,000 case studies.

"More than half the people in Britain die from a heart attack or stroke," says Prof. Martin. "Risk factors such as smoking, high cholesterol and high blood pressure have all been treated individually in the past. Now, all the quantifiable risk factors have been taken together".

Factors fed into the program, include the patient's age, sex, blood pressure, blood cholesterol levels, heart size, heart rhythm, and whether he or she has diabetes or a family history of deaths from heart disease.

Prof. Martin feeds my details into the computer. As a non-diabetic non-smoking woman aged 26 without high blood pressure or a strong history of heart disease in the family, I have luck on my side.

My risk of dying from a stroke is around one per cent, but there is only a 0.1 per cent chance that I will succumb to a heart attack.

I am delighted. But, on reflection, perhaps a one per cent chance of dying from a stroke before reaching 36 is a little high? Still, it is also a 99 per cent chance of not dying from a stroke.

"What if I took up smoking and ate three times as many chips (French fries)?" I ask Prof. Martin. He keys in a slightly higher cholesterol reading, and a smoking habit. The computer calculates.

My risks increase, but are still minimal. "You have two big advantages: your youth and the fact that you are a woman," he says.

Yet before women become too smug, they should remember that heart disease is rising as a cause of death among older women possibly because women are smoking more.

Who is at a serious risk of a heart attack? Between us we devise a portrait of John, a 59-year-old bon viveur. John, luckily, hasn't got diabetes or an unusual heart rhythm. But he does smoke. He likes butter, eggs and chips, so his cholesterol is on the high side. His heart is a bit big, his blood pressure a little high, and his brother recently died of a heart attack.

I am becoming rather attached to John when the computer tells me he has a 50 per cent chance of dying from a heart attack in the next 10 years and a 38 per cent chance of having a fatal stroke.

What can he do? "He can stop smoking," says Prof. Martin. Instantly, John's heart attack risk plummets to 41 per cent and his stroke risk to 25 per cent.

Then John can cut out the egg and chips. On a low-cholesterol diet, his heart attack risk goes down to 29 per cent. And pills can bring John's blood pressure from 170 to 120 taking his heart attack risk down to 20 per cent and stroke risk to 18 per cent.

With further lowering of cholesterol, John's risk is not far off the average for his peer group (16 percent chance of a heart attack, six per cent chances of a stroke.) Will the computer's predictions turn patients into obsessive worriers? Prof. Martin thinks not: "It will be able to reassure some worriers that there's nothing wrong with them. And for patients who might have cause for worry, it will empower them to decide with their doctor how they can really start reducing their risk."

– Sunday Telegraph

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