Change in calculated cardiovascular risk due to guideline revision: A cross-sectional study in the Netherlands

Figures & data

Table 1. Differences in additional risk factors, used for determining recommendations for medication in medium-risk patients, between the two Dutch guidelines on cardiovascular risk management (2006 and 2012) and conversion of the determinants registered in the electronic medical record (EMR).

	Additional risk factor		Conversion of EMR registration to be able to assess drug recommendation
Additional risk factors	2006 guideline	2012 guideline	Registration EMR 2006	Converted to 2012
Family	CVD in a first-degree	CVD in a first-degree relative	CVD in a first-degree relative	Not converted
history	relative < 60 years	< 65 years	< 60 years
		CVD in ≥ 2 first-degree relatives	No CVD in a first-degree	No CVD in a first-degree
		< 65 years	relative < 60 years	relative < 65 years
		CVD in ≥ 1 first-degree relatives
		< 60 years
Body mass	> 30 kg/m^2	30–35 kg/m^2	BMI	Not converted
index (BMI)		≥ 35 kg/m^2
Vascular	Kidney function disorders:	< 65 years: eGFR > 60 ml/min/1.73m^2	MDRD	Not converted
outcome	eGFR < 60 ml/min/1.73m^2	Or ≥ 65 years: > 45 ml/min/1.73m^2
		< 65 years: eGFR 30–60 ml/min/1.73m^2
		Or ≥ 65 years: 30–45 ml/min/1.73m^2
	Left ventricle hypertrophy		Not assessed	Not assessed
	Intima thickening carotid		Not assessed	Not assessed
	artery
	Excessive atherosclerosis		Not assessed	Not assessed
Physical		Sedentary lifestyle	Less than ADL	Sedentary lifestyle
activity		< 30 min/d, ≤ 5 d/wk	ADL	Sedentary lifestyle
		≥ 30 min/d, ≥ 5 d/wk	More than ADL	< 30 min/d, ≤ 5 d/wk
			Healthy	≥ 30 min/ d, ≥ 5 d/wk

CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; MDRD, modification of diet in renal disease; d, day; wk, week; ADL, activities of daily living.

Table 2. Patients (n = 1248) distributed over the risk categories as well as drug recommendation (yes or no) according to the 2006 and 2012 version of the cardiovascular risk management guidelines (in %^a).

		Drug recommendation	2012
			Low risk		Medium risk		High risk
			Yes	No	Yes	No	Yes	No
2006
	Low risk	Yes	–	–	–	–	–	–
		No	–	58.2%	7.5%	4.9%	–	–
	Medium risk	Yes	–	0.4%	8.7%	1.3%	4.4%	0.1%
		No	–	0.1%	0.3%	4.6%	2.3%	0.1%
	High risk	Yes	–	–	0.2%	–	7.0%	–
		No	–	–	–	–	–	–

^aTotal percentage is 100.1% due to rounding.

Table 3. Determinants of shift in drug recommendation between the 2006 and 2012 version of the cardiovascular risk management guidelines.

	Shift in drug recommendation
Determinant	Yes n = 150	No n = 1098	Odds ratio^a (95% CI)	P-value
Male			3.521 (1.953–6.329)	< 0.0001
Total n (%)	116 (77.0)	511 (46.5)
Smoker			1.133 (0.564–2.278)	0.719
Total n (%)	26 (17.0)	176 (16.0)
Age (per year)			1.073 (1.032–1.115)	0.001
Mean	57.9	55.0
Range^b	41–65	40–65
SBP (per 10.0 mm Hg)			1.210 (1.047–1.399)	0.011
Mean	157.4	152.1
Range^b	115–180	115–180
TC/HDL ratio (per 1.0)			1.297 (1.064–1.581)	0.011
Mean	5.3	4.9
Range^b	3.5–7.9	3.5–8.0

SBP, systolic blood pressure; TC, total cholesterol; HDL, HDL–cholesterol.

^aOdds ratios are shown for shift in drug recommendation compared to no shift in drug recommendation.

^bLowest and highest value of the separate imputation sets reported as range.