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Jun 12, 2018

Calculations of Cardiovascular Risk are Outdated, Study Finds

New Zealand study finds current tools greatly overestimate 5–year risk of developing heart disease.

Tools used to identify participants at high risk for heart disease could use a major update, based on a New Zealand study that found our existing calculations of cardiovascular risk are no longer accurate.

Published in The Lancet, this study developed a new tool for estimating future risk for heart disease. The tool was then compared with existing risk calculations, which researchers fear has become largely outdated.

According to authors, current risk calculations are based on studies from decades ago, when public health was far different than it is today. Back then, rates of heart events were much higher and preventive medications were not as widely used as they are now. Authors also note that populations have become more diverse and older data does not account for differences in things like education, income and race.

To address this issue, researchers compiled more current data of New Zealand adults from 2002–2015 through the PREDICT study. They then used the information to develop updated equations for estimating cardiovascular risk.

Researchers found that existing tools may be overestimating cardiovascular risk by up to 60%.

The study included 401,752 healthy New Zealand adults who enrolled during a routine health care visit between 2002 and 2015. Participants were ages 30–74 and free of heart disease at the start of the study, then followed for an average of four years.

Overall, 4% of participants experienced heart events during the study period. Using this data, researchers calculated that the 5–year risk for heart events was 2.3% in women and 3.2% in men. When using present risk calculations on the same population, current tools overestimated risk by 40% in men and by 60% in women.

Authors also note that lower income and education was associated with increased risk. Maori, Pacific and Indian adults had 13–48% higher cardiovascular risk than Europeans, while Chinese and other Asians had 25–33% lower risk for heart events.

What findings show, according to authors, is that current tools may be overestimating cardiovascular risk. They also may overlook key differences in race and socioeconomic status, which are influential in risk for heart disease and heart events. As a result, we could be over-treating some patients at low risk for heart disease while under-treating others.

However, it’s important to note that the recent study only included New Zealand adults, so findings cannot be generalized to the U.S. population.

Authors encourage new studies to provide a more current picture of public health and to help improve risk predictions. While rates of heart events may have decreased over the years, heart disease is still the leading cause of death in the United States. Having accurate tools to identify high-risk individuals is critical to helping patients prevent life-threatening events and improving outcomes.

Questions for You to Consider

  • Why is the prediction of cardiovascular risk important?

  • Cardiovascular risk prediction is important because it helps determine whether lifestyle modification and/or medical treatment is needed to help reduce risk for heart disease in a patient. If a person is at intermediate or high risk for heart disease, it’s important to take steps to reduce cardiovascular risk and improve heart health.

  • How can I reduce my risk for heart disease?
  • You can reduce your risk for heart disease by maintaining a healthy weight, eating a heart-healthy diet and staying physically active. Any additional risk factors, such as high blood pressurecholesterol and diabetes, should be properly addressed and controlled through lifestyle changes and working with your healthcare provider.

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