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Senior Citizen Health & Medicine
New Tool Developed for Earlier Prediction of
Cardiovascular Risk in Women
Could have an immediate effect on
cardiovascular prevention
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 "New assessment for women's risk of heart disease
may change risk status for millions of American women"
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Feb. 15, 2007 On the heels of news that the
number of heart attack deaths suffered by women is already decreasing,
researchers have announced a more accurate way to predict the risk of
developing cardiovascular disease among women, which can lead to
preventive treatment.
In the decade between 1956 and 1966, investigators
in Framingham, Mass., defined age, hypertension (high blood pressure),
smoking, diabetes and hyperlipidemia (high cholesterol levels) as major
determinants of coronary heart disease and coined the term coronary risk
factors, according to background information in the study published in
the February 14 issue of JAMA.
Over time, these markers were codified into global
risk scores for assessment of cardiovascular risk. However, for women,
up to 20 percent of all coronary events occur in the absence of these
major risk factors, whereas many women with traditional risk factors do
not experience coronary events.
The authors note that although understanding of
cardiovascular disease has changed dramatically in the past
half-century, the algorithms (predictive models) for women are largely
unchanged from those recommended 40 years ago.
Paul M Ridker, M.D., M.P.H., from Brigham and
Womens Hospital, Boston, and colleagues, developed and validated
cardiovascular risk algorithms for women based on a large set of
traditional and new risk factors.
The researchers assessed 35 risk factors among
24,558 initially healthy women (free of cardiovascular disease and
cancer at the beginning of the study) 45 years or older from the Womens
Health Study who were followed up for a median of 10.2 years for
incident (new) cardiovascular events, such as myocardial infarction
(heart attack), ischemic stroke, coronary revascularization, and
cardiovascular deaths.
The researchers used data among a randomly selected
two-thirds of the women (16,400) to develop new algorithms that were
then tested to compare observed and predicted outcomes in the remaining
one-third of women (8,158).
The new algorithms are called the Reynolds Risk
Score and the clinically simplified model for non-diabetic women
includes age, systolic blood pressure, current smoking, total and HDL
cholesterol, high sensitivity C-reactive protein (CRP) and parental
history of myocardial infarction before age 60.
In these analyses, large proportions of women with
10-year risk estimates of 5 percent to less than 10 percent or of 10
percent to less than 20 percent based on current ATP-III (Adult
Treatment Panel III) risk scores were reclassified at either higher or
lower risk of total cardiovascular disease when either of the new
algorithms was used, the researchers found.
We developed, validated and demonstrated highly
improved accuracy of two clinical algorithms for global cardiovascular
risk prediction that reclassified 40 percent to 50 percent of women at
intermediate risk into higher- or lower-risk categories, the authors
write.
As 8 to 10 million U.S. women have an ATP-III
estimated 10-year risk between 5 percent and 20 percent, application of
these data could have an immediate effect on cardiovascular prevention,
the authors conclude.
A user-friendly calculator for the Reynolds Risk
Score can be freely accessed at
http://www.reynoldsriskscore.org.
Editorial: Further Improvements in CHD Risk
Prediction For Women
Coronary heart disease (CHD) is the leading cause
of death for women and men in the United States. Because half of first
major coronary events occur in asymptomatic individuals, clinicians who
want to implement appropriate primary prevention therapy must be able to
accurately identify at-risk individuals, Roger S. Blumenthal, M.D.,
from The Johns Hopkins University School of Medicine, Baltimore, and
colleagues write in an accompanying editorial.
Future studies using multiple risk prediction
markers in conjunction with outcome data will improve the ability to
develop more accurate risk-prediction tools.
"This approach will permit more effective
identification of which asymptomatic adults need treatment with aspirin
and lipid-lowering pharmacotherapy, as well as more intensive dietary
and exercise interventions.
"Future multivariable models to predict a womans
long-term (20 to 30 years) risk of developing a major atherosclerotic
vascular disease event are also needed. The Reynolds Risk Score is an
important contribution to preventive cardiology and provides the
framework for evaluating future emerging risk factors.
Editor's Note: Dr. Blumenthal reports that he has
clinical research support from Merck, Pfizer and General Electric.
Co-authors Drs. Michos and Nasir report that they have no disclosures.
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