From the Guidelines
The assessment of cardiovascular (CV) risk should be done using the SCORE system, which estimates the 10-year risk of a first fatal atherosclerotic event, and is recommended for adult men ≥40 years old and in women ≥50 years of age or post-menopausal. This approach is supported by the European guidelines on cardiovascular disease prevention in clinical practice, as outlined in the study by 1. The SCORE system is a widely validated and recommended tool for estimating CV risk, and its use is suggested in various clinical guidelines.
When assessing CV risk, it is essential to consider the following factors:
- Age
- Gender
- Blood pressure
- Cholesterol levels
- Smoking status
- Presence of diabetes
- Family history of premature CVD
- Symptoms suggestive of CVD
The SCORE system is intended to facilitate risk estimation in apparently healthy persons, and patients who have had a clinical event such as an acute coronary syndrome (ACS) or stroke automatically qualify for intensive risk factor evaluation and management. As noted in the study by 1, the use of risk prediction instruments may change over time due to secular trends in risk factors and treatments.
More recent studies, such as the one by 1, have highlighted the importance of risk prediction tools in cardiovascular disease prevention, and have suggested the use of online tools, such as U-prevent.com, which provides prediction algorithms for all patient categories. However, it is crucial to choose the right tool for the right patient, considering medical history, geographical region, clinical guidelines, and additional risk measures.
In clinical practice, the assessment of CV risk should be done in conjunction with a comprehensive clinical assessment and patient preferences, and should guide clinical decision-making, particularly regarding the initiation of preventive measures like statin therapy. As noted in the study by 1, risk prediction tools facilitate risk communication to the patient and their family, and this may increase commitment and motivation to improve their health.
From the FDA Drug Label
The study population had an estimated baseline coronary heart disease risk of 11. 6% over 10 years based on the Framingham risk criteria and included a high percentage of patients with additional risk factors such as hypertension (58%), low HDL-C levels (23%), cigarette smoking (16%), or a family history of premature CHD (12%). The primary end point was a composite end point consisting of the time-to-first occurrence of any of the following major CV events: CV death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina or an arterial revascularization procedure.
The assessment of cardiovascular (CV) risk is based on the Framingham risk criteria, which estimates the risk of coronary heart disease over a 10-year period. The study population had an estimated baseline coronary heart disease risk of 11.6% over 10 years. The CV risk assessment includes factors such as:
- Hypertension (58% of patients)
- Low HDL-C levels (23% of patients)
- Cigarette smoking (16% of patients)
- Family history of premature CHD (12% of patients) The primary endpoint for CV risk assessment is a composite of major CV events, including:
- CV death
- Nonfatal myocardial infarction
- Nonfatal stroke
- Hospitalization for unstable angina
- Arterial revascularization procedure 2
From the Research
Assessment of Cardiovascular Risk
The assessment of cardiovascular (CV) risk is a crucial step in preventing cardiovascular disease (CVD). Several studies have highlighted the importance of estimating CV risk using population-appropriate risk equations 3.
- The atherosclerotic cardiovascular disease (ASCVD) pooled cohort equations are recommended by the American College of Cardiology/American Heart Association (ACC/AHA) to estimate risk in patients ages 40 to 79 years 3.
- A 10-year ASCVD risk estimate of 20% or higher is considered high, and patients having this level of risk should be offered and counseled to receive statin therapy 3.
- Lifestyle modifications, such as healthy diet, physical activity, weight management, and not smoking, can significantly reduce the risk of CVD 4, 5, 6.
Risk Factors for CVD
Several risk factors contribute to the development of CVD, including:
- High blood pressure 7, 5
- Diabetes mellitus 5
- Dyslipidaemias 5
- Smoking 4, 6
- Unhealthy diet 4, 5, 6
- Physical inactivity 4, 5, 6
Lifestyle Interventions
Lifestyle interventions play a critical role in preventing CVD. These interventions include:
- Not smoking 4, 5, 6
- Daily physical activity of ≥150 min/week at moderate intensity or 75 min/week for higher intensity physical activity 5
- A cardioprotective nutrition (high proportion of unsaturated fatty acids, low amounts of saturated fatty acids and low salt intake) 5
- Normal body weight (body mass index 20-25 kg/m2) 5
- Arterial blood pressure <140/90 mm Hg (optimum <130/80 mm Hg) 7, 5