CARDIOVASCULAR RISK FACTOR ASSESSMENT OF MEDICAL-STUDENTS AS AN EDUCATIONAL-TOOL

For three consecutive years, beginning in 1986, we evaluated cardiovascular disease (CVD) risk factors of medical students as part of the teaching program in a Preventive Cardiology Academic Award. Entering students in three consecutive classes were screened on the first day of orientation to medical school. The first year, we evaluated 108 students (71 men and 37 women), the second year, 99 students (75 men, 24 women), and the third year 108 students (67 men and 41 women). During the single four-hour period, we obtained data on personal and family history of CVD risk factors, type A behavior, knowledge of CVD, attitudes toward CVD prevention, measures of depression and anger, blood pressure, blood pressure reactivity, physical activity, and diet. Blood was drawn for lipid analysis. Height and weight were measured, and a physical fitness step test was administered. Pulmonary function was measured during the third year. We used a four-tiered approach to preventive cardiology education. During the assessment session, abnormalities, such as elevated blood pressure or abnormal pulse, were discussed with the student. In the second tier, the data were analyzed and returned to all students during teaching sessions, enabling them to compare their levels with the class and the national averages. For the third tier, students with high-risk values, defined as low-density lipoprotein cholesterol level greater-than-or-equal-to 150 mg/dL, a total cholesterol or triglyceride level greater-than-or-equal-to 200 mg/dL, or blood pressure greater-than-or-equal-to 140/90 mmHg, were seen by faculty physicians who suggested remedial interventions in separate sessions. For the fourth tier, core epidemiology lectures have used these data to illustrate principles of epidemiological research. We conclude that a risk factor screening program for medical students is feasible and can be conducted at a relatively low cost. The transfer of information to students in tiers constitutes a major teaching opportunity. Data obtained during the screening can stimulate early intervention for students with emergent risk factors. For other students, individualized data make preventive cardiology concepts more relevant, thus reinforcing the teaching value of the assessment.