The importance of total cardiovascular risk assessment in clinical practice

Figures & data

Figure 1.  Cumulative cardiovascular risk [6]. Risk factors: HDL-C < 0.85–0.91 mmol/l (<33–35 mg/dl); total cholesterol 5.7–6.2 mmol/l (220–239 mg/dl); SBP 150–160 mmHg; cigarette smoking (+); diabetes (+); ECG, ventricular hypertrophy. (Reprinted from Medical Clinics of North America, 79, Kannel WB & Wilson PW, An update on coronary risk factors, 951–971, Copyright (1995), with permission from Elsevier.)

Table I.  Ten-year risk of death from cardiovascular disease from the SCORE chart for high-risk European populations [5].

	Subject 1	Subject 2
Gender	Female	Male
Age (y)	60	60
Smoking status	Non-smoker	Smoker
Cholesterol level (mmol/l)	8.0	5.0
Systolic blood pressure (mmHg)	120	140
10-y risk of death (%)	2	10

Figure 2.  The Framingham risk charts [31]. To assess CHD risk in people without clinically manifest CHD, with multiple (>2) risk factors, use the Framingham risk scoring system to assign point values for age, total cholesterol, HDL-C, systolic BP and smoking status. The total number of points derived from scores in the five categories corresponds to a specific 10-y CHD risk.

Table

Belgium 10 641 Denmark 9945 Finland 37 296 France 7337 Germany 3968 Italy 53 439

Norway 48 425 Russia 3325 Spain 4701 Sweden 7435 UK 7292 UK – Scotland 12 285

Figure 3.  The new risk charts based on SCORE data—in low-risk regions—based on (A) total cholesterol (URL for downloadable SCORE charts for cholesterol: http://www.escardio.org/initiatives/prevention/SCORE+Risk+Charts.htm) or (B) total cholesterol/HDL-C ratio [5]. (Reprinted from European Heart Journal, 24, Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project, 987–1003, Copyright (2003), with permission from the European Society of Cardiology.) Qualifiers (20) Note that total CVD risk may be higher than indicated in the chart: • As the person approaches the next age category • In asymptomatic subjects with pre-clinical evidence of atherosclerosis (e.g. CT scan, ultrasonography) • In subjects with a strong family history of premature CVD • In subjects with low HDL-C levels, raised triglyceride levels, impaired glucose tolerance, or with raised levels of CRP, fibrinogen, homocysteine, apolipoprotein B or lipoprotein(a) • In obese and sedentary subjects

Figure 4.  The new risk charts based on SCORE data—high-risk regions—based on (A) total cholesterol, or (B) total cholesterol/HDL-C ratio [5]. (Reprinted from European Heart Journal, 24, Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project, 987–1003, Copyright (2003), with permission from the European Society of Cardiology.) Qualifiers (20) Note that total CVD risk may be higher than indicated in the chart: • As the person approaches the next age category • In asymptomatic subjects with pre-clinical evidence of atherosclerosis (e.g. CT scan, ultrasonography) • In subjects with a strong family history of premature CVD • In subjects with low HDL-C levels, raised triglyceride levels, impaired glucose tolerance, or with raised levels of CRP, fibrinogen, homocysteine, apolipoprotein B or lipoprotein(a) • In obese and sedentary subjects

Kannel WB, Wilson PW. An update on coronary risk factors. Med Clin North Am 1995; 79: 951–71

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Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003

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Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.

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