Joint British Societies risk chart (JBS 2)
| Background info: JBS2 |
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1) End-points measured
- 10 year CVD risk prediction with combined endpoint of
- Coronary heart disease (CHD): fatal and non-fatal myocardial infarction and new angina
- Stroke: fatal and non-fatal stroke and cerebral haemorrhage
- Transient cerebral ischaemia
- Excluding aortic aneurysm or lower limb ischaemia
- CVD risk threshold of 20% over the next 10 years as an indication for the introduction of statin therapy.
- Note: charts provided are for age groups, <50, 50-59, > or = 60, however, risk given for these three age ranges are based on the actual ages of 49, 59 and 69. Therefore, charts will tend to overestimate risk within the two younger age bands and overestimate risk for those aged <69 and underestimate risk for those aged > or = 70.
- Chart not used for those already considered to be at high risk of CVD:
- those with existing CHD or other major atherosclerotic disease
- Familial hypercholesterolaemia or other inherited dyslipidaemias
- Renal dysfunction including diabetic nephropathy
- Type 1 and 2 diabetes mellitus
2) Profile of original population at baseline
- Chart generated based on framingham algorithm
3) Validation
| Author | Year | Ethnicity | Age group | Follow up | Population impact (% decrease in first CVD events) |
|---|---|---|---|---|---|
| McElduff (1) | 2006 | UK (men only) | 49-65 | 10 years | -27% (JBS2), -21.8% (ATP III^), -19.6% (European^^) |
Note:
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3) Length of follow up
- Short run vs. Long run validity
4) Risk factors involved
- Non modifiable risk factors
- Gender
- Age
- Ethnicity (South Asian origin)
- Family history of CVD
- Modifiable risk factors
- 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
- User friendliness of variables (rank them)
- Inclusion of modifiable risk factors
6) Future work
- JBS3
- The new JBS3 guideline will be available in Spring, next year.
- Instead of the traditional 10 year risk model used in JBS2 and other risk scales, it will present the idea of vascular age versus chronological age.
- The aim of this paradigm shift is to encourage life style changes in patients by presenting them with a lifetime readout of their CVD risk. Read more about it here
References
Primary publication:
Wood D, Wray R, Poulter N, et al. JBS2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005;91(suppl V):v1-52. http://heart.bmj.com/content/91/suppl_5/v1.short
1. McElduff P, Jaefarnezhad M, Durrington PN. American, British and European recommendations for statins in the primary prevention of cardiovascular disease applied to British men studied prospectively. Heart. 2006;92(9):1213-1218.