Levels Of Coronary Heart Disease Risk Research Articles

Framingham equations overestimate risk of coronary heart disease mortality in British males

Question What is the predictive accuracy of the Framingham risk score for coronary heart disease in a UK population? Study Design Prospective cohort study. Main results The Framingham equation significantly over-predicted 10-year coronary heart disease (CHD) mortality (predicted mortality 4.1% vs . observed mortality 2.8%; over-prediction of risk 47%; P<0.0001 for goodness of fit). The Framingham equation significantly over-predicted 10 year CHD event rate (predicted event rate 16.0% vs. observed event rate 10.2%; over-prediction of risk 57%; P<0.0001 for goodness of fit). Authors’ conclusions The Framingham equations over-predict risk of CHD mortality and all fatal and non-fatal CHD events in a representative sample of British men. The disparity seen is likely to represent actual differences in the levels of CHD risk in the Framingham population and the British male population.

Incidence, prevalence and coronary heart disease risk level in known Type 2 diabetes: a sentinel practice network study in the Basque Country, Spain

The aim of this study was to determine the incidence, prevalence and coronary heart disease risk in patients with known Type 2 (non-insulin-dependent) diabetes mellitus in a Basque Country sentinel practice network study. During the year 2000 we did a survey among sentinel practitioners who registered information about previously and newly diagnosed Type 2 diabetic patients older than 24 years of age. We studied 65,651 people attending a primary care service in the Basque Country Health Service-Osakidetza. We collected information about diabetic complications and cardiovascular risk factors and measured the coronary heart disease risk in these patients. In the year 2000, the standardized cumulative incidence and prevalence of known Type 2 diabetes were 5.0 per 1000 (CI 95%: 4.9-5.1) and 4.6% (CI 95%: 4.5-4.7) respectively. Macroangiopathy was the most frequent complication both in the newly diagnosed (21.6%) and previously known Type 2 diabetic patients (33%). Total cholesterol > or =5.17 mmol/l and LDL cholesterol > or =2.58 mmol/l were found in 75% and 90% of newly diagnosed and 65% and 85% of previously diagnosed Type 2 diabetic patients respectively. Of the Type 2 diabetic patients 42% were obese and 80% had high blood pressure. More than 55% of the men compared with 44% of the women with Type 2 diabetes had high or very high risk of coronary heart disease (p<0.05). We report new epidemiological data on known Type 2 diabetes in the Basque Country. These patients have a high frequency of cardiovascular risk factors causing a high coronary heart disease risk.

Absolute risk assessment in the clinical setting

Absolute risk assessment in the clinical setting

Best practice — ongoing polemics

Current treatment strategies and disease management programs for hyperlipidemia employ a range of lipid-lowering drugs. Results from early lipid-lowering trials using diet, fibrates, niacin and other classes of drug showed that lowering plasma cholesterol can significantly reduce the risk of developing ischemic cardiovascular events. The landmark statin trials have clearly demonstrated the benefits of lipid-lowering therapy in coronary heart disease (CHD) prevention and unlike early lipid-lowering studies, a reduction in mortality may become evident with statin therapy during the first year of treatment. The number of successful lipid-intervention trials continues to increase and evidence is accumulating that lipid modification can also reduce the risk of cardiovascular events among individuals with only modest degrees of blood–lipid abnormalities. With increasingly powerful drugs to modify blood lipids, the potential levels at which to initiate treatment and the appropriate target levels are rapidly changing and debate surrounds the question of where the line to initiate treatment should be drawn. The relative lack of major adverse events with statin therapy means that the level of CHD risk at which clinical benefit occurs cannot be determined by the degree of risk at which benefit exceeds adverse events. Therefore, patients with only moderately raised cholesterol levels can be treated because statin treatment is well tolerated. One of the most important aspects of the statin trials is the finding that clinical events, such as death and disability due to coronary artery disease, may be preventable or limited in a significant number of patients if they receive aggressive therapy. Current goals for cholesterol levels in patients with established CHD are rarely achieved with non-aggressive treatment; however, with aggressive lipid lowering statins can achieve these goals in a safe and effective manner.

What role for statins? A review and economic model.

What role for statins? A review and economic model.

A multifactorial approach to coronary disease risk assessment.

Coronary heart disease (CHD) remains a major cause of morbidity and mortality in Western societies. Hypertension has been identified as a cardinal risk factor for CHD. Guidelines for hypertension classification and treatment are based on the results of clinical trials that have demonstrated reductions in cardiovascular endpoints in treated hypertensive patient. Controversy persists regarding the level of blood pressure at which treatment should be initiated and the desirable blood pressure goals of treatment. Several algorithms for CHD risk prediction have been developed. This report will review one recently developed approach for predicting CHD risk based upon observational data from the Framingham Heart Study. A rationale is presented for considering absolute level of CHD risk to guide hypertension treatment.