Assessment Of Total Cardiovascular Risk Research Articles

Assessment of Total Cardiovascular Risk Using WHO/ISH Risk Prediction Chart Among Adults in Oman: A Nationally Representative Survey.

Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality globally and in Oman. Stratifying the population under different risk levels based on the total CVD risk approach using the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction chart would be more effective in primary prevention of CVD to prioritize and utilize valuable resources. Hence, this study aimed to assess the total 10-year CVD risk among adults in Oman and to ascertain the proportion of the population in need of pharmacotherapy. We used the data from the 2017 national community-based STEPS survey conducted among men and women in Oman aged 40-80 years. Ten-year total cardiovascular risk was measured using the WHO/ISH risk prediction chart for Eastern Mediterranean Sub-Region B. Independent t-test and Chi-square were used to test significance. There were 2510 participants in the study. Their mean age was 51.5±10.1 years and 51.3% were male. The prevalence of low, moderate, and high CVD risk was 68.0%, 19.1%, and 12.9%, respectively, as benchmarked by the WHO/ISH chart. Immediate pharmacotherapy was needed by 30.3% of participants. Factors significantly associated with elevated CVD risk were the participant's age (p < 0.001), education level (p < 0.001), and employment status (p < 0.001). A substantial fraction of the population in Oman are at moderate or high CVD risk. Prompt pharmacological interventions are warranted for at least one in every five individuals in conjunction with lifestyle changes.

Primary care physicians' awareness and perceptions on adherence to primary cardiovascular disease prevention guidelines in Lebanon: A cross-sectional study.

To assess the awareness and have an insight on practice patterns of primary care physicians (PCPs) with respect to several professional primary cardiovascular diseases (CVDs) preventive guidelines. This is a cross-sectional study, questionnaire-based using a non-probability convenience sampling. Data collection occurred at the annual conferences of the Lebanese Societies of General Practice, Family Medicine, and Internal Medicine in Lebanon. 104 PCPs were recruited. Awareness and practices of CVDs preventive guidelines. The response rate was 37%. Awareness of the various CVD preventive guidelines was high among PCPs (&gt;81%). Around 69% of PCPs reported that they always calculate the total cardiovascular risk assessment score. Gaps in managing patients according to guidelines' recommendations were higher in statin initiation compared to antihypertensive initiation. There is over prescription of statin in low risk patients and underutilization in high risk patients. Around 20% of PCPs would initiate aspirin for a low risk patient. Around 17% of physicians do not perform abdominal aortic aneurysm screening. Although PCPs demonstrated high level of awareness regarding CVD preventive guidelines, gaps remain present in managing patients according to guidelines' recommendations. Less adherence to guidelines will increase mortality and affect patient care.

ОЦЕНКА ИНФОРМИРОВАННОСТИ ВРАЧЕЙ ПЕРВИЧНОГО ЗВЕНА О СУММАРНОМ СЕРДЕЧНО-СОСУДИТОМ РИСКЕ

In practical medicine, the assessment of total cardiovascular risk (CVR) plays an important role in identifying a high-risk group among “asymptomatic” patients, that is, individuals without clinical manifestations of atherosclerosis. Currently, the most famous are the American Framingham Total Coronary Risk Scale, as well as the European SCORE (Systematic Coronary Risk Evaluation) scale, which predicts the 10-year fatal risk of all CVDs for European countries with low and high risk. The survey involved 66 doctors from various regions of Uzbekistan

Total cardiovascular risk assessment of women in delta state, Nigeria, using the world health Organization/International Society of Hypertension risk prediction chart

Background: Globally, women are not exempt from the menace of cardiovascular diseases. Methods: This cross-sectional study assessed the 10-year cardiovascular risk (CVR) for stroke or myocardial infarction of women aged ≥18 years attending opportunistic medical screening programs in two suburban communities in Delta State, Nigeria. Consenting women were consecutively recruited for the study, and the study instrument was the World Health Organization/International Society of Hypertension prediction chart for Africa (AFR D) without blood cholesterol. Total CVR was graded as low ( 40 years, 9.9% had never married, and 39.9% had a secondary level of education. The mean body mass index (29 vs. 27 kg/m2), systolic blood pressure (140 vs. 121 mmHg), diastolic blood pressure (87 vs. 77 mmHg), and blood glucose (104 vs. 92 mg/dl) were significantly higher among women aged ≥40 years. Smoking, hyperglycemia, and hypertension were noted in 0.0%, 7.0%, and 34.4% of the women, respectively. The 10-year risk of stroke or myocardial infarction was low in 87.7%, moderate in 7.2%, and high in 5.0% of the women. All the respondents with high CVR were aged ≥40 years. Among respondents aged

Wiek naczyń — u kogo i jak go oceniać? Czy możemy „odmłodzić” naczynia naszych pacjentów?

Total cardiovascular risk assessment plays a key role in the prevention of cardiovascular disease (CVD). It facilitates identification of patients with increased CVD risk and allows to plan appropriate actions to reduce or eliminate risk factors. The SCORE chart is a practical tool for estimation of individual 10-year risk of fatal CVD. However, in young patients with risk factors, the absolute risk calculated with the SCORE chart may be low despite significantly elevated relative risk. In this group of patients, assessment of cardiovascular risk age (heart age, vascular age) may be useful for identification of individuals in whom intensive preventive measures should be implemented. These measures should focus on reducing existing risk factors, which in some patients might require the use of pharmacotherapy. Statins were proven to be effective in CVD risk reduction, including primary prevention. Statins significantly lower concentrations of low-density lipoproteins, which are crucial for the development of atherosclerosis. Moreover, beyond their cholesterol- -lowering properties, statins exert pleiotropic effects, leading to inhibition or even partial reversal of unfavorable changes within the vessel wall, and to a reduction of cardiovascular risk age.

Standardization of laboratory lipid profile assessment: A call for action with a special focus on the 2016 ESC/EAS dyslipidemia guidelines – Executive summary: A consensus endorsed by the Cardiovascular Risk and Prevention Group of the Portuguese Internal Medicine Society, the Portuguese Atherosclerosis Society, the Portuguese Society of Cardiology, the Portuguese Society of Laboratory Medicine, and the Portuguese Association of Clinical

Even with improvements in lifestyle interventions, better control of cardiovascular (CV) risk factors, and improvements in CV outcomes, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in Portugal and Europe. Atherogenic dyslipidemias, particularly hypercholesterolemia, have a crucial causal role in the development of atherosclerotic CVD. The clinical approach to a patient with dyslipidemia requires an accurate diagnosis, based on harmonized and standardized lipid and lipoprotein laboratory assessments. Results and reports of these tests, together with assessment of total CV risk and the respective therapeutic targets, will help ensure that clinical guidelines and good clinical practices are followed, increasing the reliability of screening for lipid disorders, producing more accurate diagnoses and CV risk stratification, and improving CV prevention. To this end, this consensus aims to provide clinicians with practical guidance for the harmonization and standardization of laboratory lipid tests, focusing on the most recent dyslipidemia management guidelines.

Carotid Intima-Media Thickness in Patients with Diabetes Mellitus Attending Tertiary Care Hospital in Nigeria

Objective: Carotid intima-media thickness is a significant and independent predictor of coronary artery disease in patients with diabetes. The aim of our study was to determine carotid intima-media thickness in Nigerians with diabetes.Methods: This was an observational cross-sectional study involving consecutively presenting patients with type 2 diabetes mellitus and healthy age-matched adults. Anthropometric variables were measured, and blood samples collected for fasting blood sugar, cholesterol, and HbA1c. Carotid intima-media thickness was measured using a 2-D scanner. Association of carotid intima-media thickness with other variable was assessed using correlation and multivariable linear regression models.Results: One hundred and fifty two subjects (87 diabetics and 65 healthy adults) were studied. Carotid intimamedia thickness was significantly higher among diabetics. Seventy nine (90.8%) and seventy two (82.8%) patients with diabetes had carotid intima-media thickness greater than 0.9 mm and 1.0 mm respectively. Carotid intimamedia thickness was higher in patients with higher HbA1c, fasting blood sugar, body mass index, total cholesterol and LDL cholesterol, and significantly correlated with HbA1c, age, fasting blood sugar, systolic blood pressure, total cholesterol, LDL-c and HDL-c. Age, HbA1c and duration of hypertension predicted increased carotid intima-media thickness.Conclusion: The prevalence of increased carotid intima-media thickness is extremely high among Nigerians with diabetes, and this significantly correlated with other risk factors for cardiovascular diseases. Assessment of carotid intima-media thickness should be routinely included in evaluation of subjects with diabetes, and assessment of total cardiovascular risk.

Evaluation of Cardiovascular Risk and Blood Pressure Parameters in Patients with Bronchial Asthma and Co-Existent Chronic Obstructive Pulmonary Disease

The combination of arterial hypertension, asthma and COPD has a significant prevalence in clinical practice. The presence of hypertension contributes to the growth of severity of asthma-COPD overlap (ACO), the worst prognosis and a high risk of cardiovascular complications. Coexistence of diseases changes the course of each of them, contributes to the early formation of complications and creates certain difficulties for therapy.The aim of work was to investigate the factors of cardiovascular risk, as well as the arterial pressure indicators of patients with ACO.Patients. 140 patients with ACO with an average forced expiratory volume for the first second (FEV1) (59.0 ± 1.4)% and the ratio of forced expiratory volume in the first second to the forced vital capacity of the lungs (FEV1 / FVC) (53.6 ± 0.8)%. Methods. All the patients underwent measurement of body weight and height, measurement of office systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour ambulatory blood pressure monitoring (ABPM), biochemical blood test, coagulogram, assessment of total cardiovascular risk on a SCORE scale, the risk of cardiovascular complications on QRISK2 scale, the risk of developing diabetes mellitus (DM) on QDiabetes scale.Results. Patients with ACO had some pathological changes in blood pressure. Also, these patients had a significant overload with arterial pressure. Also, in these patients, the diurnal index (DI) of SBP and DI DBP were significantly reduced relatively to normal values.Patients with ACO predominantly belonged to the group of moderate risk of fatal cardiovascular events in 10 years (3.83%). The QRISK2 is quite significant, and is more than 15%. There is also a fairly significant risk of developing DM (more than 13%).A higher concentration of inflammational markers was revealed in ACO patients with more severe bronchial obstruction (significant increase in C-reactive protein and fibrinogen with increased bronchial obstruction).ACO patients from subgroups GOLD 1 and GOLD 2 predominantly belonged to the group of moderate risk, and patients from the GOLD 3.4 subgroup predominantly had a high risk of developing fatal cardiovascular events over the next 10 years (according to the SCORE scale). The QRISK2 scale risk was also moderate in the first two subgroups and high in patients with severe bronchial obstruction (GOLD 3,4).Conclusions. In patients with a combination of asthma and COPD, significant cardiovascular comorbid pathology, a high prevalence of arterial hypertension, a high degree of overload with arterial pressure were found. Significant violations of the variability of blood pressure were also revealed. In this category of patients, a moderate risk of developing fatal cardiovascular events, as well as the development of diabetes within the next 10 years is also determined. Even more significant violations of blood pressure and high rates of cardiovascular risk were detected in patients with a combined pathology with a higher degree of bronchial obstruction.

Cardiovascular Risk Assessment: A Systematic Review of Guidelines.

Many guidelines exist for screening and risk assessment for the primary prevention of cardiovascular disease in apparently healthy persons. To systematically review current primary prevention guidelines on adult cardiovascular risk assessment and highlight the similarities and differences to aid clinician decision making. Publications in MEDLINE and CINAHL between 3 May 2009 and 30 June 2016 were identified. On 30 June 2016, the Guidelines International Network International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and Web sites of organizations responsible for guideline development were searched. 2 reviewers screened titles and abstracts to identify guidelines from Western countries containing recommendations for cardiovascular risk assessment for healthy adults. 2 reviewers independently assessed rigor of guideline development using the Appraisal of Guidelines for Research and Evaluation II instrument, and 1 extracted the recommendations. Of the 21 guidelines, 17 showed considerable rigor of development. These recommendations address assessment of total cardiovascular risk (5 guidelines), dysglycemia (7 guidelines), dyslipidemia (2 guidelines), and hypertension (3 guidelines). All but 1 recommendation advocates for screening, and most include prediction models integrating several relatively simple risk factors for either deciding on further screening or guiding subsequent management. No consensus on the strategy for screening, recommended target population, screening tests, or treatment thresholds exists. Only guidelines developed by Western national or international medical organizations were included. Considerable discrepancies in cardiovascular screening guidelines still exist, with no consensus on optimum screening strategies or treatment threshold. Barts Charity.

Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia.

BackgroundRecent research has used cardiovascular risk scores intended to estimate “total cardiovascular disease (CVD) risk” in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted.MethodsThis study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40–64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated.ResultsThe prevalence of WHO/ISH “high CVD risk” (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to “high risk”. Of those at “moderate risk” (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication).ConclusionsUsed on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs.At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues.

Total Cardiovascular Risk Assessment and Management Using Two Prediction Tools, with and without Blood Cholesterol

Over the last decade, total cardiovascular risk assessment and management has been recommended by cardiovascular prevention guidelines in most high-income countries and by WHO. Cardiovascular risk prediction charts have been developed based on multivariate equations of values of some well-known risk factors such as age, sex, smoking, systolic blood pressure and diabetes, including or omitting total blood cholesterol. The objectives of this study were: to determine the distribution of cardiovascular risk in a Cuban population using the WHO/International Society of Hypertension risk prediction charts with and without cholesterol; and to assess applicability of the risk prediction tool without cholesterol in a middle-income country, by evaluating concordance between the two approaches and comparing projected drug requirements resulting from each (at risk thresholds of ≥20% and ≥30%) and for the single-risk-factor approach. From April through December 2008, a cross-sectional study was conducted in 1287 persons (85.8% of the sample selected), aged 40-80 years living in a polyclinic catchment area of Havana, Cuba, based on the protocol and data from a WHO multinational study. The study used the two sets of the WHO and the International Society of Hypertension (WHO/ISH) risk prediction charts, with and without cholesterol. Percentages and means were calculated, as well as prevalence (%) of risk factors. The chi-square test was used to compare means (p ≤0.05). Concordance between the two prediction charts was calculated for different risk levels, using the chart with cholesterol as a reference. Using the risk assessment tools with and without cholesterol, 97.1% and 95.4% respectively of the study population were in the ten-year cardiovascular risk category of <20%, while 2.9% and 4.6% respectively were in the category of ≥20%. Risk categories were concordant in 88.1% of the population; overestimation was higher among the nonconcordant (136/153). When risk assessment did not include cholesterol, there was 2.6% (34/1287) overestimation of drug requirements and 0.5% (6/1287) underestimation, compared to estimates including cholesterol. Total cardiovascular risk assessment using the WHO/ISH charts without cholesterol could be a useful approach to predict cardiovascular risk in settings where cholesterol cannot be measured. This does not introduce overconsumption of drugs, but does enable better targeting of resources to those who are more likely to develop cardiovascular disease. KEYWORDS Cardiology, risk assessment, health risk appraisal, hypertension, health policy, cost savings, atherosclerosis, Cuba.

Modern statin therapy in clinical practice: The lower the better

Lipid and lipoprotein disorders are well known risk factors for atherosclerosis and its complications. The level of atherogenic LDL-cholesterol (LDL-C) is directly related to an increased risk of occurrence and progression of ischemic heart disease. Epidemiological and clinical studies have shown that the use of statin therapy to decrease LDL-C can significantly reduce the incidence of mortality, major coronary events and the need for revascularization procedures in the different groups of patients. The findings of a large meta-analysis conducted by the Cholesterol Treatment Trialists' (CTT) collaborators showed that every 1.0 mmol/l reduction of atherogenic LDL-C is associated with a 22% reduction in cardiovascular diseases mortality and morbidity. However, despite the impressive results of the benefits of statin therapy, the EUROASPIRE study showed that about 50% of patients with ischemic heart disease did not achieve target LDL-C levels. According to the new ESC/EAS Guidelines for the Management of Dyslipidaemias in patients with a very high cardiovascular risk, treatment goal should be to decrease LDL-C below 1.8 mmol/l or > or = 50% of initial values. In the majority of patients that can be achieved by statin therapy. For this reason an adequate choice of statins is of crucial importance, whereby the needed reduction in atherogenic LDL-C, after the identification of its target level based on the assessment of total cardiovascular risk, can be achieved.

Left ventricular hypertrophy

Left ventricular hypertrophy

SHA 024. Total cardiovascular risk assessment: What do doctors know about?

SHA 024. Total cardiovascular risk assessment: What do doctors know about?

IMPACT OF 2007 ESH-ESC GUIDELINES ON CARDIOVASCULAR RISK STRATIFICATION IN PATIENTS WITH UNCOMPLICATED ESSENTIAL HYPERTENSION: PP.20.307

Objective: Total cardiovascular risk determines decisions on treatment strategies in hypertensive patients. The 2007 ESH-ESC guidelines have proposed a new risk stratification scheme. The aim of the study was to assess cardiovascular risk in uncomplicated hypertensive patients comparing approaches of 2007 and 2003 ESH-ESC guidelines. Methods: In 576 non-diabetic essential hypertensive patients without established cardiovascular or renal disease (291 male, 53.0 ± 10.1 years (M ± SD), BMI 29.4 ± 4.4 kg/m2, 38% smokers, BP 156 ± 13/99 ± 8 mmHg, creatinine 94.3 ± 17.4 μmol/l, fasting plasma glucose 5.2 ± 0.6 mmol/l, LDL 3.7 ± 0.9 mmol/l, HDL 1.2 ± 0.3 mmol/l, TG 1.7 ± 0.7 mmol/l) blood chemistry and urine analysis, electrocardiogram, albumin/creatinine urine ratio, echocardiogram, carotid ultrasonogram, plethysmography or applanation tonometry were performed for assessment of total cardiovascular risk according both stratification schemes. Results: According to 2003 ESH-ESC guidelines 8.9, 36.1, 44.5 and 10.2% patients were considered at low, moderate, high and very-high added risk, respectively. Deletion of hsCRP >1 mg/dl from risk factors, taking into account ankle/brachial BP index <0.9 as organ damage (OD) had no significant impact on risk stratification. Use of new dyslipidemia criteria and taking into account signs of impaired carbohydrate metabolism resulted in 8.5 and 8.9% (p < 0.05 for each) increase of high/very high risk group. Equating of metabolic syndrome with OD increased high/very high risk group by 50.2% (p < 0.05). Use of carotid-femoral pulse wave velocity >12 m/s as OD and implementation of new criteria of subclinical kidney damage resulted in 15.4 and 56.4% (p < 0.05 for each) increase of high/very high risk patients. Conclusions: The 2007 ESH-ESC guidelines stratify a higher proportion of hypertensive patients in the high/very high risk groups than do 2003 guidelines. More than 80% uncomplicated hypertensive patients in outpatient hospital clinic have a high/very high added risk according to the 2007 ESH-ESC risk assessment approach. Re-classification of patients in high/very high group is mainly influenced by metabolic syndrome detection and implementation of decreased glomerular filtration rate or creatinine clearance as signs of subclinical organ damage.

Systematic Review of Guidelines on Cardiovascular Risk Assessment

To appraise guidelines on cardiovascular risk assessment to guide selection of screening interventions for a health check. Guidelines in the English language published between January 1, 2003, and May 2, 2009, were retrieved using MEDLINE and CINAHL. This was supplemented by searching the National Guideline Clearinghouse, National Library for Health, Canadian Medical Association Infobase, and G-I-N International Guideline Library. We included guidelines developed on behalf of professional organizations from Western countries, containing recommendations on cardiovascular risk assessment for the apparently healthy population. Titles and abstracts were assessed by 2 independent reviewers. Of 1984 titles identified, 27 guidelines met our criteria. Rigor of guideline development was assessed by 2 independent reviewers. One reviewer extracted information on conflicts of interest and recommendations. Sixteen of 27 guidelines reported conflicts of interest and 17 showed considerable rigor. These included recommendations on assessment of total cardiovascular risk (7 guidelines), dyslipidemia (2), hypertension (2), and dysglycemia (7). Recommendations on total cardiovascular risk and dyslipidemia included prediction models integrating multiple risk factors, whereas remaining recommendations were focused on single risk factors. No consensus was found on recommended target populations, treatment thresholds, and screening tests. Differences among the guidelines imply important variation in allocation of preventive interventions. To make informed decisions, physicians should use only the recommendations from rigorously developed guidelines.

The assessment of total cardiovascular risk in hypertensive subjects in primary care

Background. Recently published guidelines emphasize that detection of any subclinical target organ damage in hypertensive subjects should be regarded as a sign of high cardiovascular risk.Aim. To assess the ability of conventional multivariable cardiovascular disease risk prediction tools and high-sensitivity C-reactive protein (hs-CRP) to identify hypertensive subjects with target organ damage.Methods. Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and base-line variables were measured in hypertensive subjects aged 45–70 years without established cardiovascular or renal disease or known diabetes.Results. Of the 495 subjects, 123 (24.8% (95% CI 21.1–28.9)) had ABI <1.00, 81 (16.4% (95% CI 13.2–19.9)) had ECG-LVH, and 41 (8.3% (95% CI 6.0–11.1)) had eGFR <60 mL/min/1.73 m2. In patients with SCORE <5% or Framingham risk <20%, any sign of target organ damage was found in 46% and 49% of patients, respectively.Conclusion. Assessment of ECG-LVH, ABI, and eGFR reclassifies a significant number of hypertensive patients to the high-risk category as compared to SCORE and Framingham risk prediction tools only.

Staging of Hypertension and Total Cardiovascular Risk Assessment: Related but Not the Same—Challenge for the Hypertension Specialist

Staging of Hypertension and Total Cardiovascular Risk Assessment: Related but Not the Same—Challenge for the Hypertension Specialist

The importance of total cardiovascular risk assessment in clinical practice

Background: The Third Joint European Guidelines on Cardiovascular Disease (CVD) Prevention highlight the importance of total cardiovascular risk prediction in planning preventive strategies. Aim: To review the development of risk prediction systems in Europe and the practicalities of utilizing risk prediction in everyday clinical practice. Methods: Randomised clinical trials, cohort studies and current guidelines for the management of cardiovascular risk were reviewed. Relevant articles published between 1960 and 2004 were identified on PubMed and the Internet. Results: Several risk factors have been confirmed as major independent predictors of CVD, with their modification reducing cardiovascular risk. Total risk assessment is essential as multiple risk factors confer greater risk than the sum of their components. Framingham Heart Study data have been used as the basis for several risk prediction systems, which have been incorporated into numerous guidelines. However, these data are from a relatively small American cohort and tend to overestimate risk in some European populations. This and other limitations prompted the development of the SCORE (Systematic Coronary Risk Evaluation) risk charts using a much larger dataset from 12 European cohort studies. An electronic version of the charts, HeartScore, is now available to provide practitioners with an interactive risk prediction and management system that can be tailored to individual countries.Conclusion: Evidence-based risk assessment systems can facilitate logical, individually tailored risk management and contribute to better patient care. Secular changes in coronary heart disease (CHD) incidence and mortality as well as in risk factors such as obesity and diabetes mean that such systems should be capable of modification and evolution.

Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension.

Clinical decision-making in hypertensive patients is largely based upon assessment of total cardiovascular risk. World Health Organization-International Society of Hypertension (WHO-ISH) guidelines suggest delaying or withholding drug treatment in individuals assessed as at low risk on the basis of a suggested work-up that does not include echocardiography. To assess the impact of echocardiography on risk stratification in never-treated individuals classified as at low cardiovascular risk. A retrospective analysis of a prospective survey. Outpatient hypertension clinics of three community hospitals. A total of 792 hypertensive adults classified as at low or medium risk, drawn from a larger sample of 1322 never-treated hypertensive patients. Change in risk class and need of immediate treatment after echocardiographic evaluation of left ventricular hypertrophy. Those at low and medium risk according to WHO-ISH (to receive delayed treatment) represented 17 and 43%, respectively, of the whole hypertensive population. The prevalence of left ventricular hypertrophy on echocardiography was 21 and 32% in low- and medium-risk groups, respectively (29% on average). In untreated hypertensive individuals without overt target-organ damage, in whom treatment would be postponed or avoided according to current WHO-ISH guidelines, echocardiography modifies the risk classification in 29% of the cases, identifying a need for immediate drug treatment. In low-risk untreated hypertensive individuals, echocardiography commonly alters risk stratification based on the initial WHO-ISH work-up.