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New Guidelines for Predicting Cardiovascular Disease

Electronic tool and updated information identifies patients at risk of heart attack, stroke
CHICAGO --- The next time you see your primary care doctor, he or she will have access to updated guidelines and a new electronic tool that can better predict your chances of developing cardiovascular disease, including heart attack and stroke.

The guidelines -- released today from the American College of Cardiology and the American Heart Association -- were developed by a work group co-chaired by Donald M. Lloyd-Jones, M.D., senior associate dean, chair and professor of preventive medicine at Northwestern University Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital.

“These new recommendations will help doctors better identify which patients may benefit from lifestyle changes, drug therapy or both to help prevent future cardiovascular disease-related events,” Lloyd-Jones said.

Past guidelines, which were last updated in 2004, only included data from Caucasians and focused on predicting one’s short-term (10-year) risk for coronary heart disease events such as a heart attack. Stroke risk was not a factor in the past guidelines. The new guidelines are based on a broader population sample, including African-Americans, and include stroke risk and both short-term and lifetime cardiovascular disease risk.

The latest data from the National Heart, Lung, and Blood Institute-sponsored, community-based cohort studies show that among women and African-Americans, the risk for coronary events happens later and the risk for stroke comes earlier when compared to white men.

“We were tending to under treat women and African-Americans during important years in theirs 40s, 50s and 60s, because we weren’t fully capturing their risk,” Lloyd-Jones said. “We are now smarter about identifying risk and treating more people who will benefit.”

The new recommended electronic assessment tool, which calculates a patient’s “cardiovascular risk score,” can be integrated into electronic health records or downloaded on a spreadsheet. The tool uses formulas to calculate a score based on factors such as age, race, gender, blood pressure, smoking, diabetes and cholesterol. The tool displays a percentage and a graphic that shows a patient’s individualized 10-year and lifetime risk versus someone his or her age with optimal risk levels.

“The formulas we have built into the tool can provide your risk score in seconds,” Lloyd-Jones said. “This score helps inform the discussion about how intensive doctors and patients need to be to prevent cardiovascular disease and stroke caused by atherosclerosis and to determine if lifestyle changes alone can prevent a future event or if medication is needed as well.”

Atherosclerosis is a buildup of plaque that can eventually harden and narrow the arteries, potentially leading to heart attack and stroke.

The group charged with making these new recommendations also looked closely at existing literature on promising new technologies in the field of cardiology, which include CT scans and urine and blood tests to detect possible heart conditions. While the group does not support using these new risk measures routinely, if a doctor and patient are on the fence about treatment after the risk score has been calculated, there are four measures that show the most helpful assessment potential:
  • Family history of premature cardiovascular disease in first-degree relatives (before age 55 in your father or 65 in your mother)
  • Coronary artery calcium score, which can show the presence of plaque in artery walls
  • High-sensitivity C-reactive protein levels (higher levels have been associated with heart attack and stroke)
  • Ankle brachial index, the ratio of the blood pressure in the ankle compared to blood pressure in the arm
“These measure are reasonable for some situations, but we are not recommending them for routine assessment, and they should only be used after the risk equation exercise has been performed,” Lloyd-Jones said.