Cardiovascular risk factors: when should we treat?

Evaluation of cardiovascular diseases risk calculators for CVDs prevention and management: scoping review

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality globally. This review aimed to summarise evidence on the key features, usability and benefits of CVD risk calculators using digital platforms for CVDs prevention and management in populations.

METHODS

We used search engines and thematic analyses to conduct a scoping review. As the reporting guideline for this review, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

RESULTS

A total of 17 studies meeting eligibility criteria were included in the analysis, from which about 70% of the studies have prognostic level I (n = 8) and level II (n = 4) evidence. The review found that various guidelines are recommending different algorithms for CVD risk prediction. The QRISK® was the most accurate CVD risk calculator for several study populations, whereas World Health Organization/International Society of Hypertension (WHO/ISH) risk scores were the least accurate. The key features of CVD risk calculators are variables, predictive accuracy, discrimination index, applicability, understandability, and cost-effectiveness.

CONCLUSION

For the selected risk prediction tool, development and validation research must be done, which considers a mix of stroke-specific risk and CVD risk to establish its usability in the local community and advantages to the particular health-care environment. To get healthcare professionals more involved in preventing and treating CVDs, each healthcare setting should use an online CVD risk assessment tool that is more useful, accurate, and easy to use, based on the population and health system.

Improving attendance for cardiovascular risk assessment in Australian general practice: an RCT of a monetary incentive for patients

BACKGROUND

Preventive health care is an important part of general practice however uptake of activities by patients is variable. Monetary incentives for doctors have been used in the UK and Australia to improve rates of screening and immunisation. Few studies have focussed on incentives for patients to attend preventive health care examinations. Our objective was to investigate the use of a monetary incentive to increase patient attendance with their general practitioner for a cardiovascular risk assessment (CVRA).

METHODS

A pragmatic RCT was conducted in two Australian general practices. Participating GPs underwent academic detailing for cardiovascular risk assessment. 301 patients aged 40-74, who did not have cardiovascular disease, were independently randomised to receive a letter inviting them to a no cost cardiovascular risk assessment with their GP, or the same letter plus an offer of a $25 shopping voucher if they attended. An audit of patient medical records was also undertaken and a patient questionnaire administered to a sub sample of participants. Our main outcome measure was attendance for cardiovascular risk assessment.

RESULTS

In the RCT, 56/301(18.6%) patients attended for cardiovascular risk assessment, 29/182 (15.9%) in the control group and 27/119 (22.7%) in the intervention group. The estimated difference of 6.8% (95% CI: -2.5% to 16.0%) was not statistically significant, P = 0.15. The audit showed that GPs may underestimate patients' absolute cardiovascular risk and the questionnaire that mailed invitations from GPs for a CVRA may encourage patients to attend.

CONCLUSIONS

A small monetary incentive does not improve attendance for cardiovascular risk assessment. Further research should be undertaken to determine if there are other incentives that may increase attendance for preventive activities in the general practice setting.

CLINICAL TRIALS REGISTRATION

ACTRN12608000183381.

A literature review of the cardiovascular risk-assessment tools: applicability among Asian population

BACKGROUND

Cardiovascular diseases, the main causes of hospitalisations and death globally, have put an enormous economic burden on the healthcare system. Several risk factors are associated with the occurrence of cardiovascular events. At the heart of efficient prevention of cardiovascular disease is the concept of risk assessment. This paper aims to review the available cardiovascular risk-assessment tools and its applicability in predicting cardiovascular risk among Asian populations.

METHODS

A systematic search was performed using keywords as MeSH and Boolean terms.

RESULTS

A total of 25 risk-assessment tools were identified. Of these, only two risk-assessment tools (8%) were derived from an Asian population. These risk-assessment tools differ in various ways, including characteristics of the derivation sample, type of study, time frame of follow-up, end points, statistical analysis and risk factors included.

CONCLUSIONS

Very few cardiovascular risk-assessment tools were developed in Asian populations. In order to accurately predict the cardiovascular risk of our population, there is a need to develop a risk-assessment tool based on local epidemiological data.

Lipid treatment guidelines and cardiovascular risk for Aboriginal people in Central Australia

OBJECTIVE

To evaluate the extent to which the current Pharmaceutical Benefits Scheme (PBS) guidelines for patient eligibility for lipid-lowering medication are applicable to Aboriginal people in Central Australia.

DESIGN, SETTING AND PARTICIPANTS

A 10-year cohort study of 659 Aboriginal people who participated in population-based cardiovascular disease (CVD) risk factor surveys in 1995 and who were free of CVD at baseline, for the period from 1995 to 2004-2005 or until first CVD event. Evidence of atherosclerotic CVD (ischaemic heart disease, ischaemic stroke, and peripheral vascular disease) was sought from hospital, primary health care and death records. PBS eligibility was assigned according to the current PBS criteria, which were amended in 2006 to include Aboriginal-specific criteria, using participants' baseline (1995) and 10-year follow-up data.

MAIN OUTCOME MEASURES

Proportions of PBS-eligible and PBS-ineligible participants who had CVD events during the study period; sensitivity and specificity of the criteria.

RESULTS

Of 42 participants who had CVD events during the study period, 35 were PBS-eligible (incidence, 1130/100 000 person-years; relative risk compared with PBS-ineligible population, 4.87 [95% CI, 2.19-10.80]) and seven were PBS-ineligible. PBS eligibility was associated with older mean age (37 v 32 years) and male sex (48% v 37%), with 50.7% of participants (334/659) meeting eligibility criteria. The mean high-density lipoprotein cholesterol level at baseline was very low in both groups (0.81 v 0.87 mmol/L). The current PBS guidelines have low specificity (52%) in this population, which was found to improve (to 71%-82%) by incorporating additional non-lipid criteria (age and multiple non-lipid risk factors).

CONCLUSION

The current PBS lipid treatment criteria, which include any Aboriginal person with diabetes and less stringent cholesterol thresholds than the previous version, identify a group at very high risk of CVD. Global risk assessment may better identify those at risk.

Heart failure: how can we prevent the epidemic?

Heart failure prevalence is increasing because of the ageing of the population and the longer survival of people experiencing myocardial infarction and heart failure. The lifetime risk of developing heart failure in Western countries is about 20%. The increasing prevalence of overweight, obesity and diabetes is likely to accelerate heart failure incidence. While there have been major advances in treating heart failure, a preventive approach promises greater benefit to a larger proportion of the community. The medical strategy for heart failure prevention, based on calculation of individual risk, is focused on the minority of individuals who exceed an arbitrary risk threshold. A public health strategy targeting the whole population offers a greater prospect of reducing the incidence of heart failure and other cardiovascular disease. A multitiered approach, encompassing environmental determinants of lifestyle, legislation, and education about healthy lifestyles throughout life, in addition to aggressive control of risk factors in high-risk individuals, is likely to have the greatest impact.

Cardiovascular disease in the Asia-Pacific region: challenges for health research and policy

Risk factors and diseases in developing countries are becoming "westernised".