New Risk Assessment Tool Accurately Predicts Cardiovascular Risk
Using data collected from nearly 11,000 initially healthy American men, researchers from Brigham and Women's Hospital (BWH) have devised a Web-based formula that uses information on C-reactive protein and family history to more accurately predict risk of heart attack, stroke, or cardiovascular death among men. In addition to usual risk factors like age, cholesterol, blood pressure, and smoking, the new assessment tool known as the Reynolds Risk Score for Men adds information on two additional factors, parental history of heart attack prior to age 60 and blood level of high sensitivity C-reactive protein (hsCRP), a measure of artery inflammation. Using the new risk assessment tool, the researchers found that nearly 20 percent of men in the study could be reclassified into higher or lower-risk categories with greatly improved accuracy.
For the millions of American men currently classified at "intermediate risk," use of the Reynolds Risk Score provides doctors and their patients a much clearer picture of expected risk and therefore is an important step towards "personalized medicine" to ensure that the right preventive therapies are given to the right patients. Application of the new Reynolds Risk Score for men should help physicians decide where the greatest impact of diet and exercise can be made, and will help to better target therapies including aspirin and statins.
"Beyond providing an opportunity for improved risk classification for men similar to that currently available for women, we believe these findings have potential importance for more accurately targeting preventive therapies," said cardiologist Paul Ridker, director of the Center for Cardiovascular Disease Prevention at BWH and lead author of the study. "The findings further demonstrate the important role that inflammation and parental history can have in risk prediction, even in the setting of optimized access to preventive care."
The Reynolds Risk Score for men derived from an evaluation of 10,407 initially healthy men enrolled in the Physician's Health Study II in 1995 who were followed prospectively for more than a decade for the occurrence of first heart attack, stroke, and other major cardiovascular events. The researchers first evaluated traditional approaches to risk prediction in these men using a model based on cholesterol level, history of smoking, blood pressure and age. They then added family history of heart attack prior to age 60 and hsCRP level, and directly compared the new prediction tool to the traditional approach. The two new risk factors proved crucial to better understanding cardiovascular risk in these men, each representing an important advance in the biology of heart disease.
"Using the Reynolds Risk Score, we found that about 20 percent of all men had either higher or lower cardiac risk than we would have presumed based on more traditional approaches" Ridker explained. "Correctly classifying risk is crucial for those of us trying to get the right preventive drug to the right patient and to do so as cost-effectively as possible". The new risk prediction algorithm comes on the heals of the large-scale JUPITER trial demonstrating that individuals with elevated hsCRP levels markedly benefit from statin therapy.
Both the Reynolds Risk Score for Men and the Reynolds Risk Score for Women are freely available at www.ReynoldsRiskScore.org. In addition to providing men and woman with an improved estimate of their risk of suffering a future heart attack, stroke, or other major cardiovascular event over the next 10 years, the Reynolds Risk Score website simultaneously shows each person what his or her risk would be if they improved each of their individual risk factors to optimal levels. For some young people, risk may appear low over the next 10-years, yet can be very high over a lifetime. The Reynolds Risk Score also allows people to calculate risk as they age, demonstrating the impact that risk reduction early in life can have on future events. The Reynolds Risk Score website provides useful links to prevention programs from the National Heart Lung and Blood Institute, the American Heart Association, and the American College of Cardiology.