I have been thinking a lot lately about the concept of risk and benefit. Over the last 20 to 25 years or so we have become quite adept at calculating risk for individual patients. Certainly from a cardiovascular point of view we are very good at defining high risk individuals, i.e. those at a high likelihood of having a first or subsequent adverse CV event. To date our strategy has been to treat high risk individuals aggressively, attempting to reduce CV events. In many cases this is completely appropriate. My concern is that sometimes high risk individuals may not benefit from CV risk reduction (ie BP lowering) and may in fact be harmed. These are often individuals with significant completing health concerns or co-morbidities. It is in these clients where the health care individual needs to move beyond risk assessment and ask questions to help identify potential benefit. Clients who have major competing co-morbidities may not benefit from LDL lowering or BP reduction and may be harmed physically or even financially by over aggressive treatment.