CVD Risk Calculations

[David GuestParticipant]

The CVD risk calculator estimates the risk of a cardiovascular event in the next five years. It is suggested that a figure greater than 10% may merit treatment.

Many factors will play a role in an individual’s decision on whether to go on treatment but a 9% risk in a 28 year old seems much more significant than 9% in a 73 year old.

Are there any guidelines on age specific use of these risk calculators?

[Dr Dan EwaldParticipant]

I think the main missing thing here is the patients perception of the significance of the risk. For me , I would do a lot to reduce my risk 10% or even reduce by 5%.
The CVD risk calculators give us the risk without treatment but dont show us the impact of treatment on the risk.
To suggest treatment should be done above a certain risk is missing out on the patients perception of the risk. This has to balanced against our role a managers of the health budget and cost effectiveness.

[TLKeymaster]

James McCormack (of http://therapeuticseducation.org, my favourite podcast) has a Risk Calculator at

http://bestsciencemedicine.com/chd/calc2.html

This shows the effect of different treatments on risk, and displays the risk pictorially. Even though it is in beta, it is worth a look.

The algorithm used in this tool (and the Australian cvdcheck.org.au tool) uses Framingham data.

In New Zealand, the team lead by Rod Jackson at the University of Auckland are collecting their own data from primary care and calculating their own algorithm. I like this model. They have accumulated a very large database. Their tool is available at
Heart Forecast Online. Note that you are meant to be a kiwi to use it – c’mon the All Blacks.

I guess, Dan, using these tools depends on what changes as a result.
For primary prevention –

• Control your blood pressure
• Don’t smoke
• Exercise regularly
• Consider a Statin, Aspirin if high risk > 15%

What else works?

As far as age specific risk goes, I don’t believe we have any data on people aged younger than 45. I’m not sure a 29 year old could have a 9% risk, but I get your point.

There has been some debate in NZ over whether lifetime risk should be used rather than 5 or 10 year risk. The problem for that is that for most men, lifetime risk approaches 100%!

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