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cardiovascular risk calculator; cardiovascular risk score

See references. Also see QRisk score. Clinical significance: - 10 year cardiovascular risk score: - < 10% = low risk (USPSTF), < 7.5% AHA/ACC - 10-20% = intermediate risk (USPSTF), 7.5%-20% AHA/ACC - > 20% high risk - Medicare payment for cardiovascular risk assessment in medium to high risk patients reduced risk of first myocardial infarction or stroke by 0.3% within 5 years without increasing Medicare costs [20] Notes: - 7 studies have found flaws in the ACC/AHA calculator [8] - ACC/AHA calculator [6] will lead to millions of patients inappropriately prescribed statins [8] - among people with an ACC/AHA risk score of 7.5%-10%, the actual event rate was only 3% in men & 5.1% in women [9] - numerous cardiovascular risk calculators compared [13] - guidelines from the American Heart Association & the American College of Cardiology recommend calculating cardiovascular risk using 2013 Pooled Cohort Equations [15] - a revised calculator adding new cohorts & removing one old cohort from the data pool finds overestimation of 10-year risk by ~20%, with even higher among blacks [15] - nearly 12 million adults in US with previously calculated 10 year CV risk > 7.5% currently qualifying for statin therapy would no longer be eligible [15] - AHA admits calculator overestimates risk in certain groups (upper socioecomic status, those engaged in healtcare), but underestimates risk in other groups [17] - HIV1 infection associated with underestimation of risk [16] - rheumatoid arthritis associated with underestimation of risk [16,17] - AHA Predicting Risk of CVD EVENTs (PREVENT) equations among US adults 30-79 years of age without known CVD includes traditional risk factors: smoking status, systolic blood pressure, cholesterol, antihypertensive use, statin use, diabetes mellitus & eGFR [22] - use of PREVENT equations may reduce the number of patients eligible for primary prevention of cardiovascular disease with statin therapy [23,24] - pooled cohort equations overestimate 5-year risk in veterans [18] - overestimation of CV risk in people screened for diabetes may result in unnecessary treatment of other cardiac risk factors [19]

Related

cardiac risk assessment cardiovascular disease (CVD)

Specific

Framingham Risk Score/Calculator QRISK score; QRISK2 score; QRISK3 score Reynolds risk score

General

risk calculator risk assessment numerical rating scale (NRS)

References

  1. Coronary Heart Disease Risk Calculator Medical College of Wisconsin http://www.mcw.edu/calculators/CoronaryHeartDiseaseRisk.htm
  2. Smith DB (Excel file) Personal Stroke Risk (over the next 10 years) http://www.westernstroke.org/PersonalStrokeRisk1.xls
  3. Prescriber's Letter 17(11): 2010 Common Cardiovascular Risk Calculators Detail-Document#: 261124 (subscription needed) http://www.prescribersletter.com
  4. National Cholesterol Education Program (NCEP) http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof
  5. Framingham Risk Score Calculator http://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php
  6. 2013 Prevention Guideline Tools CV Risk Calculator American Heart Association American College of Cardiology http://cvdrisk.nhlbi.nih.gov/calculator.asp http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp
  7. Kolata G New York Times, November 17, 201 Risk Calculator for Cholesterol Appears Flawed http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?_r=0
  8. Cook NR, Ridker PM Further Insight Into the Cardiovascular Risk Calculator. The Roles of Statins, Revascularizations, and Underascertainment in the Women' Health Study. JAMA Intern Med. Published online October 06, 2014 PMID: 25285455 http://archinte.jamanetwork.com/article.aspx?articleid=1910550 - Nissen SE Prevention Guidelines. Bad Process, Bad Outcome. JAMA Intern Med. Published online October 06, 2014 PMID: 25285604 http://archinte.jamanetwork.com/article.aspx?articleid=1910542
  9. DeFilippis AP et al An Analysis of Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic Cohort. Ann Intern Med. 2015;162(4):266-275 PMID: 25686167 http://annals.org/article.aspx?articleid=2118596 - Ridker PM, Cook NR Comparing Cardiovascular Risk Prediction Scores. Ann Intern Med. 2015;162(4):313-314 PMID: 25686171 http://annals.org/article.aspx?articleid=2118606
  10. Deprecated reference
  11. Pandya A et al Cost-effectiveness of 10-Year Risk Thresholds for Initiation of Statin Therapy for Primary Prevention of Cardiovascular Disease. JAMA. 2015;314(2):142-150 PMID: 26172894 http://jama.jamanetwork.com/article.aspx?articleid=2396476 - Pursnani A et al Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events. JAMA. 2015;314(2):134-141 PMID: 26172893 http://jama.jamanetwork.com/article.aspx?articleid=2396478 - Greenland P, Lauer MS Cholesterol Lowering in 2015: Still Answering Questions About How and in Whom JAMA. 2015;314(2):127-128 PMID: 26172891 http://jama.jamanetwork.com/article.aspx?articleid=2396463
  12. Mittleman MA et al Treatment of Blood Cholesterol to Reduce Risk for Atherosclerotic Cardiovascular Disease: Grand Rounds Discussion From the Beth Israel Deaconess Medical Center. Ann Intern Med. 2015;163(4):280-290. PMID: 26280414 http://annals.org/article.aspx?articleid=2427595
  13. Damen JA, Hooft L, Schuit E et al Prediction models for cardiovascular disease risk in the general population: Systematic review. BMJ 2016;353:i2416 PMID: 27184143 Free PMC Article - Holt T. Predicting cardiovascular disease: An over-abundance of risk models offering few real benefits to patients. BMJ 2016;353:i2621 PMID: 27185596
  14. Lloyd-Jones DM, Huffman MD, Karmali KN et al Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool. A Special Report From the American Heart Association and American College of Cardiology. Circulation. November 4, 2016 PMID: 27815375 http://circ.ahajournals.org/content/early/2016/11/03/CIR.0000000000000467 - Article contains includes a user guide & an Excel spreadsheet for calculating a person's risk (download Excel file from article) User's Guide to Million Hearts Longitudinal ASCVD Risk Assessment Tool. http://circ.ahajournals.org/content/circulationaha/suppl/2016/10/28/CIR.0000000000000467.DC1/Appendix__Users_Guide.pdf - Lloyd-Jones DM, Huffman MD, Karmali KN Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool. J Am Coll Cardiol. 2016 Oct 28. pii: S0735-1097(16)36692-X. PMID: 27825770
  15. Yadlowsky S, Hayward RA, Sussman JB et al Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk. Ann Intern Med. 2018. June 5. PMID: 29868850 http://annals.org/aim/article-abstract/2683613/clinical-implications-revised-pooled-cohort-equations-estimating-atherosclerotic-cardiovascular-disease - DeFilippis AP, Trainor P. When Given a Lemon, Make Lemonade: Revising Cardiovascular Risk Prediction Scores. Ann Intern Med. 2018. June 5. PMID: 29868856 http://annals.org/aim/article-abstract/2683614/when-given-lemon-make-lemonade-revising-cardiovascular-risk-prediction-scores
  16. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  17. Phend C. AHA: Revised Lipid Guide Boosts PCSK9s, Coronary Calcium Scans. New recommendations aim to cut statins in low-risk primary prevention. Med Page Today. Nov 10, 2018 https://www.medpagetoday.com/meetingcoverage/aha/76250 - Grundy SM, Stone NJ, Bailey AL et al 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 8. pii: S0735-1097(18)39034-X. PMID: 30423393 - Lloyd-Jones DM, Braun LT, Ndumele CE et al Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: A special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2018 Nov 3. pii: S0735-1097(18)39036-3. PMID: 30423392
  18. Vassy JL et al. Estimation of atherosclerotic cardiovascular disease risk among patients in the Veterans Affairs health care system. JAMA Netw Open 2020 Jul 1; 3:e208236 PMID: 32662843 PMCID: PMC7361654 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768238
  19. Pylypchuk R et al. Cardiovascular risk prediction in type 2 diabetes before and after widespread screening: A derivation and validation study. Lancet 2021 Jun 12; 397:2264. PMID: 34089656 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00572-9/fulltext
  20. Blue L, Kranker K, Markovitz AR et al Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending. A Randomized Clinical Trial. JAMA. 2023;330(15):1437-1447. PMID: 37847273 https://jamanetwork.com/journals/jama/fullarticle/2810696
  21. Heart Risk Calculator. Ahead Research. 2013-2019, based on 2017 ACC/AHA guideline http://www.cvriskcalculator.com/ - ASCVD Risk Estimator. American College of Cardiology http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/
  22. Khan SS, Matsushita K, Sang Y et al. Development and Validation of the American Heart Association's PREVENT Equations. Circulation. 2024 Feb 6;149(6):430-449. PMID: 37947085 PMCID: PMC10910659 (available on 2025-02-06)
  23. Anderson TS, Wilson LM, Sussman JB Atherosclerotic Cardiovascular Disease Risk Estimates Using the Predicting Risk of Cardiovascular Disease Events Equations. JAMA Intern Med. Published online June 10, 2024. PMID: 38856978 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2819821
  24. Diao JA, Shi I, Murthy VL et al Projected Changes in Statin and Antihypertensive Therapy Eligibility With the AHA PREVENT Cardiovascular Risk Equations. JAMA. 2024 Jul 29. PMID: 39073797 https://jamanetwork.com/journals/jama/article-abstract/2821624 - Grant JK, Ndumele CE, Martin SS.. The evolving landscape of cardiovascular risk assessment. JAMA 2024 Jul 29; PMID: 39073798 https://jamanetwork.com/journals/jama/fullarticle/2821628 - Khan SS, Lloyd-Jones DM. Statins for primary prevention of cardiovascular disease - With PREVENT, what's a clinician to do? JAMA 2024 Jul 29; [e-pub] PMID: 39073988 https://jamanetwork.com/journals/jama/fullarticle/2821542
  25. American Heart Association Prevent Online Calculator https://professional.heart.org/en/guidelines-and-statements/prevent-calculator