Monday, September 17, 2007

New Risk Score Improves CVD Assessments in Women

New Risk Score Improves CVD Assessments in Women

Physician’s Weekly

Roger S. Blumenthal, MD

Despite an impressive 50-plus year history of identifying women at risk for cardiovascular disease (CVD) and strokes, the Framingham risk assessment model has sometimes fallen short in its accuracy in predicting risk. This has left many physicians wondering if they can do a better job of predicting CVD events.

Wanted: Greater Accuracy

The Framingham model examines five risk factors to assess CVD: age, blood pressure, smoking, cholesterol, and diabetes. Usually, these traditional determinants have worked well as prognosticators of risk, but they can sometimes be inconsistent with regard to accuracy, particularly among women who are classified as being at “low or intermediate risk.” This is an important note because about 70% of all future heart attacks and strokes will occur among women at this risk level. Complicating the matter is millions of women are unaware of their true CVD risk and unprepared to make lifestyle modifications.

Assessing the Reynolds Risk Score

A new CVD assessment model called the Reynolds Risk Score (RRS) has been developed and may overcome some of the shortcomings of the Framingham model. The RRS appears to be a markedly more accurate assessment tool because it addresses the predictive challenges by adding two new risk factors: parental family history of heart attack prior to age 60 and blood level of C-reactive protein (CRP). In a study published in the February 14, 2007 JAMA, Paul Ridker, MD, and colleagues demonstrated improved accuracy of predicting risk in women by using the RRS. The RRS reclassified 25% to 40% of women previously categorized under the Framingham model as intermediate risk into higher or lower risk groups. Their study also tested 35 biomarkers in nearly 25,000 women who participated in the Women’s Health Study, a 10-year research project, allowing clinicians to get a better picture of the patient’s heart health.

The RRS is a web-based tool (available online at that asks patients seven questions; a calculator then computes an individual’s 10-year CVD risk levels.

The RRS website also contains a long-term, risk-aging measure that allows doctors and patients to view risks at different stages in life (eg, ages 45, 55, 65, and 75) in order to provide a futuristic sense of what might happen if patients fail to address any problematic risk factors. While the RRS is specifically designed for women, several study groups have already demonstrated that the same concepts—particularly adding family history and CRP—works well for men too.

Superior Risk Assessment May Motivate Patients

Providing patients with better CVD risk assessments can give patients a better understanding of their true risk. Physicians can seize the teachable moment and encourage patients to follow better diet and exercise habits and to stop smoking. Physicians can then prescribe preventive aspirin and lipid lowering medication when appropriate. Many patients are at higher or lower CVD risk than we previously thought, but using the RRS tool may empower physicians to reduce the prescription interventions in some patients and ensure that patients in need of these therapies will receive them. Ideally, the RRS is designed to give patients a better means of taking ownership of their own CVD risk.

Roger S. Blumenthal, MD has indicated to Physician’s Weekly that he receives clinical research support from Merck, Pfizer, Schering-Plough and GE Healthcare.

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