Abstract 205: Potential Cardiovascular Risk Reduction in High-Risk Uninsured Patients: An Analysis of the Heart Improvement Project

Abstract

Background: The Heart Improvement Project (HIP) is a cardiovascular (CV) risk reduction clinic targeting high-risk, uninsured patients. Using coronary heart disease prediction models from the Framingham Heart Study, it is possible to project an individual’s 10-year CV disease risk based on status of the following risk factors: sex, age, LDL-Cholesterol (LDL-C), HDL-Cholesterol (HDL-C), blood pressure (BP), diabetes, and smoking status. Objective: To project the reduction in CV risk associated with two levels of intervention: first-line therapy (designed to decrease the systolic BP by 15 mm Hg and LDL-C by 30%) and maximal therapy to optimally control all modifiable risk factors. Methods: Data on 251 patients (52% male, mean age 51 yrs; 48% with Diabetes, 45% smokers) from HIP were analyzed. For each patient, their Framingham Risk Scores (FRS) and 10-year Coronary Heart Disease Risk (CHDR) were calculated in three different conditions: their actual risk assessment, and that projected under first-line, and maximal therapy. The three sets of FRS and CHDR were summarized using descriptive statistics. Pairwise differences between the three sets of FRS and CHDR were tested using two-sample t-test and 95% confidence intervals for the differences were computed. Results: Table 1 shows that the mean FRSs were 7.33, 4.90, and 3.51 (under initial, first-line, and maximal conditions, respectively). The corresponding CHDRs were 13%, 8%, and 6% respectively. All comparisons were statistically significant at the p<0.001 level. Conclusions: First-line interventions for BP and lipid management can yield significant improvement in CHD risk in a population of high-risk uninsured patients.