Tim Lancaster, MD
How do risks for cardiovascular disease (CVD) events compare in primary care patients with and without a history of CVD after adjusting for traditional CVD risk factors?
Prospective cohort study with a mean 2 years of follow-up.
Primary care practices in Auckland, New Zealand.
35 760 patients 30 to 74 years of age (mean age 54 y, 57% men, 10% with a history of CVD) who had a CVD risk score calculated using the Web-based PREDICT clinical decision support program.
Based on the Framingham risk score, PREDICT uses traditional CVD risk factors (age, sex, diabetes, smoking, blood pressure, and cholesterol levels) to classify patients as having < 5%, 5% to < 10%, 10% to < 15%, 15% to < 20%, or ≥ 20% 5-year risk for a CVD event.
First CVD event (acute coronary syndrome, ischemic or hemorrhagic stroke, peripheral arterial disease, a procedure for these conditions, heart failure, or death from CVD) after the PREDICT risk score was recorded (obtained by linkage with government databases). Observed rates were extrapolated to 5 years, assuming constant incidence.
Over the follow-up period, 1216 patients had ≥ 1 CVD event, 42% of whom had a history of CVD. Extrapolated 5-year event rates were 5.2% in patients without CVD at baseline and 29% in those with CVD. The Table shows observed rates by predicted risk group.
Risk for cardiovascular disease (CVD) events increased with predicted risk category in primary care patients both with and without a history of CVD. Absolute risks were about 20 percentage points higher for patients with CVD, after adjusting for traditional risk factors.
PREDICT risk score to predict 5-year risk for cardiovascular disease (CVD) events in primary care patients with or without a history of CVD*
*Data are observed CVD event rates extrapolated to 5 years, with proportion of patients in each risk category in parentheses. Data provided by author.
Tim Lancaster. Absolute CVD risk, stratified by risk score, was 20% higher in primary care patients with CVD than in those without CVD. Ann Intern Med. 2009;150:JC5–15. doi: 10.7326/0003-4819-150-10-200905190-02015
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Published: Ann Intern Med. 2009;150(10):JC5-15.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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