Tools & Approaches for Estimating CVD Risk

• Categories for individuals considered for prevention:

  • apparently healthy people - need to establish their risk of developing CVD over the next 10 years
  • patients with established CVD - already at high risk, so need to reduce further risk
  • patients with type 2 diabetes mellitus - already at high risk, so need to reduce further risk
  • patients with specific risk factors such as chronic kidney disease and familial hypercholesterolemia - already at high risk, so need to reduce further risk
• Assessing Risk in Apparently Healthy People:

  • Use of Systematic COronary Risk Evaluation (Score2 & Score2OP) model
  • Score2 is used for people aged 40 to 69 years
  • Score2OP is used for people aged 70 + years
  • 10 year risk of fatal and non-fatal cardiovascular events in low to high risk regions
  • calculates risk using age, biological sex, smoking status, systolic blood pressure and non-HDL
• SCORE2 risk prediction algorithms:

  • derived from 13 European countries
  • involved 680,000 people free from CVD between 1990 and 2009
  • measured exposure to different risk factors to create an algorithm to estimate risk of non-fatal and fatal CVD events over a 10 year period
• • SCORE2 is calibrated in accordance to risk regions
  • the higher risk regions tend to be in the lower income categories, so may not have access to certain screening tools, vaccinations, education etc

  
• • SCORE2 charts are used without different risk regions
  • chart A would be used in lower risk regions, whereas chart D would be used in higher risk regions
  • (only using chart A in this module)

  
• SCORE2:

  • split into women and men, which is further split into smoking and non-smoking, which is further into non-HDL cholesterol (total cholesterol - HDL cholesterol) levels
  • systolic blood pressure on the left hand side
  • age in the middle

  
• CVD risk categories based on SCORE2 and SCORE2OP in apparently healthy people according to age:

  • low to moderate CVD risk (risk factor treatment not recommended)
  • < 50 years: < 2.5%
  • 50 to 69 years: < 5%
  • equal to/> 70 years: < 7.5%
  • high CVD risk (risk factor treatment should be considered)
  • < 50 years: 2.5% to < 7.5%
  • 50 to 69 years: 5% to < 10%
  • equal to/> 70 years: 7.5% to < 15%
  • low to moderate CVD risk (risk factor treatment recommended)
  • < 50 years: equal to/> 7.5%
  • 50 to 69 years: equal to/> 10%
  • equal to/> 70 years: equal to/> 15%
• Treatment Targets:

  • smoking cessation (if they smoke)
  • 150 to 300 minutes of moderate PA per week or 75 to 150 minutes of vigorous PA per week
  • Mediterranean dietary pattern
  • BP 120 - 129/70 - 79 mmHg
  • LDL-C and Non-HDL targets are individualised based on risk level
• Advantages and Disadvantages of SCORE2:

  • +
  • focuses on risk factors such as smoking, sex, non-HDL cholesterol, systolic blood pressure and age
  • easy and quick to calculate risk
  • based on a large amount of research across 13 countries
  • -
  • doesnt include all risk factors e.g. diet, BMI, CRF
• Use of SCORE2 within different ethnicities:

  • southern Asian: multiply the risk by 1.3 for Indians and Bangladeshis, and multiply the risk by 1.7 for Pakistanis
  • other Asian: multiply the risk by 1.1
  • Black Caribbean: multiply the risk by 0.85
  • Black African and Chinese: multiply the risk by 0.7
• HeartScore:

  • uses age, biological sex, systolic blood pressure, smoking history and non-HDL to calculate the 10 year risk of fatal and non-fatal CVD events
  • people who have only quit smoking in the last year would be considered a smoker