Ways to measure cardiovascular risk

Certain people such as those with established CVD, existing diabetes or presence of further risk factors are automatically considered at 'very high' or 'high' total cardiovascular risk, requiring active evaluation and management of all risk factors3. For all others, current guidelines on CVD prevention recommend the use of a risk estimation model such as Systemic Coronary Risk Estimation (SCORE)

to estimate total CVD risk, because in most people atherosclerotic CVD is the result of a combination of different risk factors that interact with each other in a complex way3. Another commonly used system is the Framingham model.

In order to estimate the lifetime CVD risk, the Joint British Societies (JBS) “HeartAge” risk calculator might be a useful tool15.

Risk assessment systems

SCORE:

Risk charts such as SCORE are designed to assist with risk estimation in healthy people with no signs of disease3,6. The SCORE system, based on European data, estimates the 10-year risk of a first fatal atherosclerotic event, for example a heart attack, stroke, or other occlusive arterial disease including sudden cardiac death3,6. Risk estimates have been produced for high and low risk regions in

Europe. A relative risk chart has also been produced for younger people, as a low absolute risk may conceal a high relative risk, requiring lifestyle advice.

To find out more about how to use the SCORE risk assessment system please see the joint EAS/ESC guidelines on the management of dyslipidemias.

 

Table 1: Possible intervention strategies as a function of total CV risk and LDL-Cholesterol level
Total CV risk
(SCORE) %
LDL-C Levels image
  <70 mg/dl
<1.8 mmol/L
70 to <100 mg/dL
1.8 to <2.6 mmol/L
100 to <155 mg/dL
2.6 to <4.0 mmol/L
155 to <190 mg/dL
4.0 to <4.9 mmol/L
≥190 mg/dL
≥4.9 mmol/L
<1 Lifestyle Advice Lifestyle Advice Lifestyle Advice Lifestyle Advice Lifestyle intervention, consider drug if uncontrolled
Classa/Levelb I/C I/C I/C I/C Il/A
≥1 to <5 Lifestyle advice Lifestyle advice Lifestyle intervention, consider drug if uncontrolled Lifestyle intervention, consider drug if uncontrolled Lifestyle intervention, consider drug if uncontrolled
Classa/Levelb I/C I/C Il/A Il/A I/A
≥5 to <10,
or high risk
Lifestyle advice Lifestyle intervention, consider drug if uncontrolled Lifestyle advice and drug treatment for most Lifestyle advice and drug treatment for most Lifestyle advice and drug treatment for most
Classa/Levelb Ila/A Ila/A Il/A I/A I/A
≥10 or very
high risk
Lifestyle advice, consider drug Lifestyle advice and concomitant drug treatment Lifestyle advice and concomitant drug treatment Lifestyle advice and concomitant drug treatment Lifestyle advice and concomitant drug treatment
Classa/Levelb Ila/A Ila/A I/A I/A I/A

CV: cardiovascular; LDL-C: low-density lipoprotein cholesterol; SCORE: Systematic Coronary Risk Estimation.

a Class of recommendation

b Level of evidence

In patients with myocardial infarction, statin therapy should be considered irrespective of total cholesterol levels.

Table from 2016 European Guidelines on cardiovascular disease prevention in clinical practice3.

 

Other Scoring Systems:

Other systems also exist, for example, the Framingham system is similar and based on US data, using information from the Framingham Heart Study to assess 10-year risk of fatal and non-fatal CVD events in patients3,13.

 

However, it has been found that it could overestimate (or underestimate) risk in populations other than the US population; therefore it is important to assess your patients using the most appropriate risk scoring system for them14.

The JBS “HeartAge” risk calculator

The JBS3 “HeartAge” risk calculator is a newly developed and easy to use tool, intended for use by GPs and other HCPs with their patients15. Differently from the other scoring systems mentioned above, this risk calculator has been developed to estimate the lifetime risk of developing a cardiovascular event in healthy people (with no established CVD), by calculating their “Heart Age”. Heart Age can differ from the chronological age, depending on the presence and severity of those modifiable risk factors that lead to CVD15.

Heart Age gives patients a better understanding of their CVD risk over their lifetime and the benefits that may be achieved by sustained long-term reduction of CVD risk factors through diet and lifestyle changes, and/or drug therapies, if necessary. To find out more information about the JBS3 "HeartAge" risk calculator, please see the Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease JBS315.