Scales for primary prevention

(all scales in this category are not for people who are already diagnosed with CVD)

Objectives

Framingham Risk Score

• For predicting risk of
  • General cardiovascular disease (10 year risk) – 2008
  • AF (10 year risk)
  • Cardiovascular disease (30 year risk)
  • Congestive heart failure
  • Coronary heart disease (2 year risk)
  • Diabetes risk score
  • Hard coronary heart disease (10 year risk)
  • Hypertension Risk Score
  • Intermittent Claudication
  • Recurring coronary heart disease
  • Stroke
  • Stroke after AF
  • Stroke or death after AF

ASSIGN

• For predicting risk of CVD (10 year risk)

JBS 2

• For predicting risk of CVD (10 year risk)

QRISK®2

• For predicting risk of heart attack and stroke (10 year risk)

ETHRISK®

• For predicting risk of CHD and CVD of British black and minority ethnic groups (10 year risk)

HeartScore

• For predicting risk of fatal cardiovascular disease events (10 year risk)

Variables

Framingham Risk Score (For general cardiovascular disease)

• Gender
• Age
• Diabetes
• Smoking status
• Treated and untreated Systolic Blood Pressure
• Lipid profile (Total cholesterol and HDL cholesterol) or BMI

ASSIGN

• Gender (being male)
• Age (being older)
• Living area (poor neighbourhood)
• Family history of CHD/Stroke
• Diabetes
• Smoking status
• Systolic blood pressure
• Lipid profile (Total cholesterol and HDL cholesterol)

JBS 2

• Gender
• Age
• Ethnicity (South Asian origin)
• Family history of CVD
• Smoking status
• Systolic blood pressure
• Diastolic blood pressure
• Lipid profile (Total cholesterol and HDL cholesterol)
• Glucose (normal / impaired fasting glucose / diabetes)
• Left ventricular hypertrophy
• Central obesity

QRISK®2

• Gender
• Age
• Ethnicity
• Living area
• Smoking status
• Diabetes
• Family history (angina or heart attack in a 1st degree relative
• Existing blood pressure treatment
• Systolic blood pressure
• Chronic kidney disease
• AF
• RA
• Lipid profile (Total cholesterol and HDL cholesterol)
• BMI

ETHRISK®

• Gender
• Age
• Ethnicity
• Systolic blood pressure
• Smoking status
• Lipid profile (Total cholesterol and HDL cholesterol)

HeartScore

• Gender
• Age
• Smoking status
• Systolic blood pressure
• Total cholesterol

Stratification & Other info

Framingham Risk Score

• Arbitrarily determined classification
  • Low risk: 10%
  • Intermediate risk: 10-20%
  • High risk: >20%
• Other information
  • Study cohort: population of Framingham, Massachusetts, USA
  • NICE Guidance (2010) emphasises that any risk calculator which are based on the Framingham risk equation may overestimate risk in UK populations (source: http://www.patient.co.uk/doctor/Primary-Cardiovascular-Risk-Calculator.htm)

ASSIGN

• Score of 1 to 99
• A score of 20 or more is considered high
• Other information
  • Score based on Scottish Heart Health Extended Cohort (SHHEC study)
  • Not for those already diagnosed with cardiovascular disease and are receiving treatment
  • Score developed despite existence of European SCORE and Framingham score to include social deprivation (of particular relevance to Scotland) and family history

(source: http://assign-score.com/about/beginners/)

JBS 2

• > 20% risk is considered sufficiently high to justify the use of anti-hypertensive and lipid lowering therapies, and for some people antiplatelet therapies as well.
• Based on Framingham but to be applied in the UK context
• Societies involved: British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, The Stroke Association.
• Identifies the limitations of the use of Framingham in the UK context
  • Framingham prediction is lower than the observed rates of hospital admission for CHD
  • Framingham prediction is lower than the observed rates of CHD among the diabetic population found by the UK prospective diabetes study (UKPDS)
  • Framingham equations do not include socio-economic status and underestimate risk in people who are relatively socially deprived.
• Other information
  • Not for people with diabetes as JBS recommends all diabetic patients be classified as high risk

(source: JBS 2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart. 2005 Dec;91 Suppl 5:v1-52.)

QRISK®2

• Data from QRESEARCH® database of UK primary care patients (1.28 million patients without diabetes or CVD followed up for 10 years)
• Validated by comparison with Framingham and ASSIGN
  • QRISK®2 found to be better calibrated to the UK population than either Framingham or ASSIGN
  • QRISK®2 vs. Framingham (Collins GS, Altman DG. An independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study. BMJ 2010;340:c2442.)
  • QRISK®2 vs. ASSIGN (http://www.qresearch.org/SitePages/qriskInformationforClinicians.aspx)
• “The Framingham equations were derived from North American populations from the 1960s to the 1980s when coronary heart disease (CHD) was at its peak and they overestimate risk in contemporary European populations by around 100% in Southern European populations and by 50% or more in Northern European populations including the UK.”
  (source: http://qrisk.org/)

ETHRISK®

• Based on Framingham
• Applicable to people aged 35 to 74 without diabetes or a previous history of CVD
• Risk calculator is currently awaiting peer review and limited by the lack of suitable cohort studies containing black and minority ethnic group people.

(source: http://www.epi.bris.ac.uk/CVDethrisk/)

HeartScore

• Recommend treatment to be initiated if 10 year risk of cardiovascular disease death exceeds 5%.
• Data from 12 European cohort studies (N=205,178)
• Applicable to people aged 40 to 65

(source: http://www.heartscore.org/SiteCollectionDocuments/HeartScoreUserGuide2008.pdf)