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
IX.
Absolute Long-Term Risk
Framingham
scoring does not directly project long-term risk (>10
years), although such risk can be approximated by the
summing of risk scores over successive age categories
and the subtraction of those persons removed by having
CHD events. Thus, 20-year risk should be at least twice
the 10-year risk. An important aim of primary prevention
is to reduce CHD over the long term and not just over
the short term. For a patient in the age range of 50 to
54 years, a 20-year projection of absolute risk may be
of more interest to both the physician and the patient
than a 10-year projection. Such a patient whose 10-year
risk for CHD is 15% may not qualify as being at high short-term
risk, but this same patient has a >30% probability
of developing CHD before age 75. This latter projection
needs to considered when primary prevention strategies
are planned.
Another
critical point to make about long-term risk is that
any single coronary risk factor, eg, cigarette smoking,
hypertension, high serum cholesterol, or diabetes, can
lead to premature CHD (or stroke) if left untreated
over a period of many years. Therefore, each of the
major risk factors deserves intervention in the clinical
setting, regardless of the short-term absolute risk.
The centerpiece of long-term risk reduction is modification
of lifestyle habits, eg, smoking cessation, change in
diet composition, weight control, and physical activity.30
Nonetheless, in patients in whom long-term risk is high,
the use of drugs for treatment of hypertension or serum
cholesterol disorders may be warranted, as described
in JNC VI7
and ATP II,6
respectively.
Copyright
© 2000 by The American Heart Association, Inc.
and
The American College of Cardiology
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