GRUNDY ET AL., Assessment of Cardiovascular Risk
J Am Coll Cardiol 1999;34:1348--59
AHA/ACC
Scientific Statement: Assessment of Cardiovascular Risk
by Use of Multiple-Risk-Factor Assessment Equations
A
Statement for Healthcare Professionals From the American
Heart Association and the American College of Cardiology
II.
Clinical Importance of Global Estimates for DHD Risk
Preventive
efforts should target each major risk factor. Any major
risk factor, if left untreated for many years, has the
potential to produce cardiovascular disease (CVD). Nonetheless,
an assessment of total (global) risk based on the summation
of all major risk factors can be clinically useful for
3 purposes: 1) identification of high-risk patients who
deserve immediate attention and intervention, 2) motivation
of patients to adhere to risk-reduction therapies, and
3) modification of intensity of risk-reduction efforts
based on the total risk estimate. For the latter purpose,
patients at high risk because of multiple risk factors
may require intensive modification of >1 risk
factors to maximize risk reduction. Guidelines for the
management of individual risk factors are provided by
the second Adult Treatment Panel report (ATP II) of the
National Cholesterol Education Program (NCEP),6
the sixth report of the Joint National Committee (JNC
VI) of the National High Blood Pressure Education Program,7
and the American Diabetes Association (ADA).8
All of these guidelines are currently endorsed or supported
by the AHA and the ACC. These reports6–8
advocate adjusting the intensity of risk factor management
to the global risk of the patient. In ATP II and JNC VI,6,7
overall risk is estimated by adding the categorical risk
factors. They do not use a total risk estimate based on
summation of risk factors that have been graded according
to severity; this latter approach has been advocated recently
by Framingham investigators.2
The use of categorical risk factors has the advantage
of simplicity but may be lacking in some of the accuracy
provided by graded risk factors.
Some
researchers and clinicians believe that the summation
of graded risk factors provides advantages over the
addition of categorical risk factors. For instance,
the use of graded risk factors has been recommended
in risk-management guidelines developed by joint European
societies in cardiovascular and related fields.9
Advocates of this approach contend that the increased
accuracy provided by the grading of risk factors outweighs
the increased complexity of the scoring procedures.
If the Framingham system is to be used, however, its
limitations as well as its strengths must be understood.
The AHA's Task Force on Risk Reduction recently issued
a scientific statement10
that reviewed and assessed the utility of Framingham
scoring as a guide to primary prevention. The present
report expands on this assessment and considers factors
that must be taken into account when the Framingham
algorithm is used.2
Copyright
© 2000 by The American Heart Association, Inc.
and
The American College of Cardiology
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