Abstract
Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk.
Highlights
Current guidelines on prevention of cardiovascular disease (CVD) such as the European Guidelines on cardiovascular disease prevention in clinical practice [1], recommend to guide decisions to take preventive actions as well as the level of preventive actions by an estimation of absolute risk of CVD based on multiple cardiovascular risk factors [2, 3]
The Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice proposed in 2003 new CVD risk charts for Europe and suggested the SCORE (Systematic COronary Risk Evaluation) project to estimate ten-year risk of fatal cardiovascular disease [4, 5]
The updated risk charts for estimation of the absolute 10-year- risk of fatal CVD in Germany are presented in Figs 1 and 2
Summary
Current guidelines on prevention of cardiovascular disease (CVD) such as the European Guidelines on cardiovascular disease prevention in clinical practice [1], recommend to guide decisions to take preventive actions as well as the level of preventive actions (e.g. lifestyle recommendations, drug treatment) by an estimation of absolute risk of CVD based on multiple cardiovascular risk factors [2, 3]. Risk charts for high-risk and low-risk European countries have been issued and in addition national or regional calibrations of the SCORE risk charts were performed in order to reflect specific mortality and risk factor levels [4, 9,10,11,12] These risk charts should be used for risk estimation in primary prevention only since patients with clinically manifest CVD are already considered as high-risk individuals [1, 4]. These trends suggested the need for an update of the risk charts for Germany in order to avoid overestimation of risk and false positive categorization of people from the general population into the high risk group
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