Screening for Future Cardiovascular Disease Using Age Alone Compared With Multiple Risk Factors and Age
What is the relative value of screening for future cardiovascular disease (CVD) events using age alone compared to screening using age and multiple risk factors based on the Framingham risk scores (FRS)?
The authors used the 10-year CVD risk in a hypothetical sample population of 500,000 people ages 0-89 years. Risk estimates were used to identify individuals who did and did not have a CVD event over a 10-year period. For screening using age alone (age screening) and screening using multiple risk factors and age (Framingham screening), they estimated the following: 1) detection rate (sensitivity); 2) false-positive rate; 3) proportion of CVD-free years of life lost in affected individuals with positive results (person-years detection rate); and 4) cost per CVD-free life-year gained from preventive treatment.
Age screening using a cut-off of 55 years detected 86% of all first CVD events arising in the population every year and 72% of CVD-free years of life lost for a 24% false-positive rate. For 5 yearly FRS screenings, the false-positive rate was 21% for the same 86% detection rate. The estimated cost per CVD-free year of life gained was £2,000 for age screening and £2,200 for Framingham screening if a Framingham screen costs £150 and the annual cost of preventive treatment is £200.
Age screening for future CVD events is simpler than Framingham screening with a similar screening performance and cost-effectiveness. It avoids blood tests and medical examinations. The advantages of age screening in the prevention of heart attack and stroke warrant considering its use in preference to multiple risk factor screening.
Using real data from prospective population studies, both the Framingham and the Reynold’s risk scores have been shown to be more accurate and discriminative than age alone. If cost is the only issue, intuitively, the most cost-effective method of screening would seem to be an assessment of risk factors in 50-year-old men and women, with the strategy to reduce lifelong risk of CV events. Those with no risk factors (nonsmoker, normal fasting blood sugar, blood pressure <120 mm Hg, high-density lipoprotein cholesterol >50 mg/dl, low-density lipoprotein cholesterol <100 mg/dl, no family history of coronary disease) could be given a free pass, and those with one or more risk factors could be treated with generic statins (Lloyd-Jones DM, et al., Circulation 2006;113:791-8).
Keywords: Stroke, Cardiovascular Diseases, Coronary Disease, Risk Factors, Hematologic Tests
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