Discussion

10-year risk versus lifetime risk

• You may have noticed that some scales, such as the Framingham and SCORE scales, uses 10-year cardiovascular risk as their end-point of measurement.
• The major limitation of these scales is that they miss many people (mainly younger people and women) with substantial lifetime risk but low 10-year risk and hence provide false reassurance.
• Example: a 45 yr old woman, smoker with hyperlipidaemia and hypertension and family history of IHD would be still be in the “green box” for the Framingham scales and the Euroscore (please see the chart).
• These individuals are unlikely to change lifestyle or treatments, but when examined will have marked elevation of lifetime risk.
• Thus, scores only measuring 10-year risks are more accurate for men and older people
• The most recent version (JBS3) of the Joint British Score predicts lifetime, instead of 10-year, cardiovascular risk.