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Absolute cardiovascular disease risk: Assessment and Early Intervention

Lecture, in Phase 2 Society and Health, in the UNSW Medicine Program 2014
by

Michael Tam

on 27 February 2015

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Transcript of Absolute cardiovascular disease risk: Assessment and Early Intervention

Aim
1. Explain the benefits
2. Identify the information
3. Demonstrate the use
4. Describe the management
of absolute CVD risk assessment
required to use the CVD risk charts
and calculator
of the CVD risk assessment tools
of a patient's cardiovascular risk according
to best practice guidelines
Age 53
Ex-smoker for 7 years
2-3 standard drinks/day
BP 165/95
2 serves of fruit a day
BMI = 30
Total chol = 7.0 mmol/L
HDL-C = 1.4 mmol/L
No diabetes
Age 65
Non-smoker
2 standard drinks/day
BP 145/92
10 min of exercise a day
BMI = 25
Total chol = 5.6 mmol/L
HDL-C = 0.7 mmol/L
No diabetes
Explain the benefits
of absolute
CVD
risk assessment
Coronary heart disease
angina, AMI, etc.
Cerebrovascular disease
stroke, TIA, etc.
Peripheral vascular disease
intermittent claudication
Prevalence


Death


Disability
1.4 million people
Impact



Risk factors
500,000 in hospital/yr
11% of total health $$$
>9 in 10 adults with 1+
2 in 3 adults with 3+
Explain the benefits
of absolute
CVD risk
assessment
Modifiable
Non-modifiable
smoking
blood pressure
serum lipids
waist circumference and BMI
nutrition
physical activity level
alcohol intake
age and sex
family history
social history (cultural identity,
ethnicity, SES, mental health)
Related conditions
diabetes
chronic kidney disease
familial hypercholesterolaemia
atrial fibrillation
Explain the benefits
of
absolute
CVD
risk
assessment
Absolute risk Relative risk
the
probability
of an event occurring within a specified period
5-year absolute CVD risk =
probability of having CVD in the next 5-year period
the
ratio
of the rates of events between two populations
e.g., smokers have a higher relative risk of CVD compared to non-smokers
Let's say that the baseline risk is 12% by age 60
AR (baseline)
= 0.12
= 12%
RRR (drugX)
= 0.25
= 25%
AR (drugX)
= AR (baseline) x (1 - RRR)
= 0.12 x 0.75
= 0.09
= 9%
ARR
= AR (baseline) - AR (drugX)
= 0.12 - 0.09
= 0.03
= 3%
NNT
= 1 ÷ ARR
= 1 ÷ 0.03
= 33
To demonstrate the clinical
application of absolute
cardiovascular disease (CVD)
risk assessment.
Why use ARR & NNT?

Patient 1
Patient 2
Patient 3
Patient 4
AR (baseline)
50%
20%
8%
0.5%
AR (drugX)
37.5%
15%
6%
0.375%
RRR
25%
25%
25%
25%
ARR
12.5%
5%
2%
0.125%
NNT
8
20
50
800
"Absolute" vs "Individual" CVD risk approach
"...[risk] depends more closely on the combination and intensity of risk factors than on the presence of a single risk factor, because the cumulative effects of multiple risk factors may be synergistic."
Algorithm
Target group
Information to gather
Already at high risk?
if "no", use risk calculator
Management
5-year absolute CVD disease risk:
Low:
Moderate:
High:
< 10%
10 - 15%
> 15%
Major epidemiologic research

Started 1948 in Framingham, MA

Study into the causes of CVD

Now into the 3rd generation of participants
7%
20%
Questions?
Thank you!
Full transcript