Cent Eur J Public Health 2015, 23(2):91-99 | DOI: 10.21101/cejph.a4004

Overview of Risk-Estimation Tools for Primary Prevention of Cardiovascular Diseases in European Populations

Vitali Gorenoi, Anja Hagen
Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany

To identify persons with a high risk for cardiovascular diseases (CVD) special tools (scores, charts, graphics or computer programs) for CVD-risk assessment based on levels of the certain risk factors have been constructed. The applicability of these instruments depends on the derivation cohorts, considered risk factors and endpoints, applied statistical methods as well as used formats. The review addresses the risk-estimation tools for primary prevention of CVD potentially relevant for European populations. The risk-estimation tools were identified using two previously published systematic reviews as well as conducting a literature search in MEDLINE and a manual search. Only instruments were considered which were derived from cohorts of at least 1,000 participants of one gender without pre-existing CVD, enable risk assessment for a period of at least 5 years, were designed for an age-range of at least 25 years and published after the year 2000. A number of risk-estimation tools for CVD derived from single European, several European and from non-European cohorts were identified. From a clinical perspective, seem to be preferable instruments for risk of CVD contemporary developed for the population of interest, which use easily accessible measures and show a high discriminating ability. Instruments, restricting risk-estimation to certain cardiovascular events, recalibrated high-accuracy tools or tools derived from European populations with similar risk factors distribution and CVD-incidence are the second choice. In younger people, calculating the relative risk or cardiovascular age equivalence measures may be of more benefit.

Keywords: cardiovascular disease, risk assessment, prevention, review, statistical models

Received: January 10, 2014; Revised: January 28, 2015; Accepted: January 28, 2015; Published: June 1, 2015  Show citation

ACS AIP APA ASA Harvard Chicago IEEE ISO690 MLA NLM Turabian Vancouver
Gorenoi V, Hagen A. Overview of Risk-Estimation Tools for Primary Prevention of Cardiovascular Diseases in European Populations. Cent Eur J Public Health. 2015;23(2):91-99. doi: 10.21101/cejph.a4004. PubMed PMID: 26851417.
Download citation

References

  1. Gohlke H. Risk stratification with difference scoring systems. ESC SCORE, Framingham risk score, PROCAM, and CARRISMA. Clin Res Cardiol. 2006;1 Suppl 2:139-48. (In German.) Go to original source...
  2. Gohlke H, von Schacky C. Total risk for cardiovascular disease.At what point is medical prophylactic medication useful?. Z Kardiol. 2005;94 Suppl 3:III/6-10. (In German.) Go to original source... Go to PubMed...
  3. Sullivan LM, Massaro JM, D'Agostino RB Sr. Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Stat Med. 2004 May 30;23(10):1631-60. Go to original source... Go to PubMed...
  4. Cooney MT, Dudina AL, Graham IM. Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians. J Am Coll Cardiol. 2009 Sep 29;54(14):1209-27. Go to original source... Go to PubMed...
  5. Berger JS, Jordan CO, Lloyd-Jones D, Blumenthal RS. Screening for cardiovascular risk in asymptomatic patients. J Am Coll Cardiol. 2010 Mar 23;55(12):1169-77. Go to original source... Go to PubMed...
  6. BeswickAD, Brindle P, Fahey T, Ebrahim S.Asystematic review of risk scoring methods and clinical decision aids used in the primary prevention of coronary heart disease. NICE clinical guidelines, no. 67S. London: Royal College of General Practitioners; 2008. Go to original source...
  7. Gorenoi V, Schönermark MP, HagenA.Assessments tools for risk prediction of cardiovascular diseases. HTA-Bericht. 2009;90:1-73. (In German.)
  8. Grover SA, Lowensteyn I. The challenges and benefits of cardiovascular risk assessment in clinical practice. Can J Cardiol. 2011 JulAug;27(4):481-7. Go to original source... Go to PubMed...
  9. Cooney MT, Dudina A, D'Agostino R, Graham IM. Cardiovascular riskestimation systems in primary prevention: do they differ? Do they make a difference? Can we see the future? Circulation. 2010 Jul 20;122(3):300-10. Go to original source... Go to PubMed...
  10. Prieto-Merino D, Pocock SJ. The science of risk models. Eur J Prev Cardiol. 2012 Aug;19(2 Suppl):7-13. Go to original source... Go to PubMed...
  11. Justice AC, Covinsky KE, Berlin JA. Assessing the generalizability of prognostic information. Ann Intern Med. 1999 Mar 16;130(6):515-24. Go to original source...
  12. D'Agostino RB Sr, Grundy S, Sullivan LM, Wilson P; CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001 Jul 11;286(2):180-7. Go to original source...
  13. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Münster (PROCAM) study. Circulation. 2002 Jan 22;105(3):310-5. Go to original source...
  14. Assmann G, Schulte H, Cullen P, Seedorf U.Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) study. Eur J Clin Invest. 2007 Dec;37(12):925-32. Go to original source... Go to PubMed...
  15. International Task Force for Prevention of Coronary Heart Disease. Coronary risk assessment [Internet]. International Task Force for Prevention of Coronary Heart Disease; 2010 [cited 2013 Apr 20]. Available from: http://www.chd-taskforce.com/coronary_risk_assessment.html.
  16. ThomsenTF, Davidsen M, Ibsen H, JørgensenT, Jensen G, Borch-Johnsen K. A new method for CHD prediction and prevention based on regional risk scores and randomized clinical trials; PRECARD and the Copenhagen Risk Score. J Cardiovasc Risk. 2001 Oct;8(5):291-7. Go to original source... Go to PubMed...
  17. Ferrario M, Chiodini P, Chambless LE, Cesana G, Vanuzzo D, Panico S, et al.; CUORE Project Research Group. Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE Cohort Study prediction equation. Int J Epidemiol. 2005 Apr;34(2):413-21. Go to original source... Go to PubMed...
  18. Giampaoli S, Palmieri L, Donfrancesco C, Panico S, Vanuzzo D, Pilotto L, et al. Cardiovascular risk assessment in Italy: the CUORE Project risk score and risk chart. Ital J Public Health. 2007;4(2):102-9.
  19. CUORE Project. Calculating the individual risk score [Internet]. Rome: Cnesps - Istituto Superiore di Sanità; 2009 [cited 2013Apr 20].Available from: http://www.cuore.iss.it/sopra/calc-rischio_en.asp.
  20. Menotti A, Lanti M, Agabiti-Rosei E, Carratelli L, Cavera G, Dormi A, et al. Riskard 2005. New tools for prediction of cardiovascular disease risk derived from Italian population studies. Nutr Metab Cardiovasc Dis. 2005 Dec;15(6):426-40. Go to original source... Go to PubMed...
  21. Centre Against Myocardial Infarction. Riskard 2009 [Internet]. Rome: Centre Against Myocardial Infarction; 2009 [cited 2013 Apr 20]. Available from: http://www.centrolottainfarto.org/riskard-2009. (In Italian.)
  22. Cooney MT, Vartiainen E, Laatikainen T, Joulevi A, Dudina A, Graham I. Simplifying cardiovascular risk estimation using resting heart rate. Eur Heart J. 2010 Sep;31(17):2141-7. Go to original source... Go to PubMed...
  23. Cooney MT, Vartiainen E, Laatikainen T, De Bacquer D, McGorrian C, Dudina A, et al.; SCORE and FINRISK investigators. Cardiovascular risk age: concepts and practicalities. Heart. 2012 Jun;98(12):941-6. Go to original source... Go to PubMed...
  24. Woodward M, Brindle P, Tunstall-Pedoe H; SIGN group on risk estimation. Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart. 2007 Feb;93(2):172-6. Go to original source... Go to PubMed...
  25. Assign score. Prioritising prevention of cardiovascular disease [Internet]. Assign Score; 2013 [cited 2013 Apr 20]. Available from: http://assignscore.com/.
  26. Hippisley-Cox J, Coupland C, VinogradovaY, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007 Jul 21;335(7611):136. Go to original source... Go to PubMed...
  27. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, et al. Predicting cardiovascular risk in England and Wales: prospective derivationandvalidationofQRISK2.BMJ.2008Jun28;336(7659):1475-82. Go to original source... Go to PubMed...
  28. Hippisley-Cox J, Coupland C, Robson J, Brindle P. Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using QResearch database. BMJ. 2010 Dec 9;341:c6624. Go to original source... Go to PubMed...
  29. QRISK®2-2013 cardiovascular disease risk calculator [Internet]. ClinRisk; 2013 [cited 2013 Apr 21]. Available from: http://www.qrisk.org/.
  30. QRISK®-lifetime cardiovascular risk calculator [Internet]. ClinRisk; 2012 [cited 2013 Apr 21]. Available from: http://qrisk.org/lifetime.
  31. MerryAH, Boer JM, Schouten LJ,Ambergen T, Steyerberg EW, Feskens EJ, et al. Risk prediction of incident coronary heart disease in The Netherlands: re-estimation and improvement of the SCORE risk function. Eur J Prev Cardiol. 2012 Aug;19(4):840-8. Go to original source... Go to PubMed...
  32. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al.; SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003 Jun;24(11):987-1003. Go to original source...
  33. European Society of Cardiology. HeartScore [Internet]. SophiaAntipolis: ESC; 2010 [cited 2013 Apr 20]. Available from: http://www.heartscore.org/Pages/online.aspx.
  34. Cuende JI, Cuende N, Calaveras-Lagartos J. How to calculate vascular age with the SCORE project scales: a new method of cardiovascular risk evaluation. Eur Heart J. 2010 Oct;31(19):2351-8. Go to original source... Go to PubMed...
  35. Balkau B, Hu G, Qiao Q, Tuomilehto J, Borch-Johnsen K, Pyörälä K; DECODE Study Group; European Diabetes Epidemiology Group. Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE Study. Diabetologia. 2004 Dec;47(12):2118-28. Go to original source... Go to PubMed...
  36. Mendis S, Lindholm LH, Mancia G, Whitworth J, Alderman M, Lim S, et al. World Health Organization (WHO) and International Society of Hypertension (ISH) risk prediction charts: assessment of cardiovascular risk for prevention and control of cardiovascular disease in low and middle-income countries. J Hypertens. 2007 Aug;25(8):1578-82. Go to original source... Go to PubMed...
  37. World Health Organization. Cardiovascular disease.WHO/ISH cardiovascular risk prediction charts [Internet]. Geneva: WHO; 2007 [cited 2012 Nov 22]. Available from: http://www.who.int/cardiovascular_diseases/guidelines/Chart_predictions/en/index.html.
  38. Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991 Jan;121(1 Pt 2):293-8. Go to original source... Go to PubMed...
  39. Anderson KM, Wilson PW, Odell PM, Kannel WB. An updated coronary risk profile. A statement for health professionals. Circulation. 1991 Jan;83(1):356-62. Go to original source...
  40. Pyörälä K, De Backer G, Graham I, Poole-Wilson P, Wood D. Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, EuropeanAtherosclerosis Society and European Society of Hypertension. Eur Heart J. 1994 Oct;15(10):1300-31. Go to original source... Go to PubMed...
  41. Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis. 1998 Oct;140(2):199-270. Go to original source...
  42. British Cardiac Society; British Hyperlipidaemia Association; British Hypertension Society; endorsed by the British Diabetic Association. Joint British recommendations on prevention of coronary heart disease in clinical practice.. Heart. 1998 Dec;80 Suppl 2:S1-29. Go to original source...
  43. British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society; Stroke Association. JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart. 2005 Dec;91 Suppl 5:v1-52. Go to original source... Go to PubMed...
  44. Jackson R. Updated New Zealand cardiovascular disease risk-benefit prediction guide. BMJ. 2000 Mar 11;320(7236):709-10. Go to original source... Go to PubMed...
  45. Jackson R, Barham P, Bills J, Birch T, McLennan L, MacMahon S, et al. Management of raised blood pressure in New Zealand: a discussion document. BMJ. 1993 Jul 10;307(6896):107-10. Go to original source... Go to PubMed...
  46. NICE. Lipid Modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease [Internet]. London: National Institute for Health and Care Excellence; 2008 [cited 2008 Sep 9]. Available from: http://www.nice.org.uk/CG067.
  47. McCormack JP, Levine M, Rangno RE. Primary prevention of heart disease and stroke: a simplified approach to estimating risk of events and making drug treatment decisions. CMAJ. 1997 Aug 15;157(4):422-8. Go to PubMed...
  48. Wolf PA, D'Agostino RB, BelangerAJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991 Mar;22(3):312-8. Go to original source... Go to PubMed...
  49. D'Agostino RB, Wolf PA, Belanger AJ, Kannel WB. Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke. 1994 Jan;25(1):40-3. Go to original source... Go to PubMed...
  50. Murabito JM, D'Agostino RB, Silbershatz H, Wilson WF. Intermittent claudication. A risk profile from The Framingham Heart Study. Circulation. 1997 Jul 1;96(1):44-9. Go to original source...
  51. Wilson PW, D'Agostino RB, Levy D, BelangerAM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998 May 12;97(18):1837-47. Go to original source...
  52. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May 16;285(19):2486-97. Go to original source... Go to PubMed...
  53. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008 Feb 12;117(6):743-53. Go to original source... Go to PubMed...
  54. Pencina MJ, D'Agostino RB Sr, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the framingham heart study. Circulation. 2009 Jun 23;119(24):3078-84. Go to original source... Go to PubMed...
  55. Framingham Heart Study. Risk score profiles [Internet]. Framingham: Framingham Heart Study; 2012 [cited 2013 Apr 20]. Available from: http://www.framinghamheartstudy.org/risk/index.html.
  56. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA. 2007 Feb 14;297(6):611-9. Go to original source... Go to PubMed...
  57. Ridker PM, Paynter NP, Rifai N, Gaziano JM, Cook NR. C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation. 2008 Nov 25;118(22):2243-51, 4p following 2251. Go to original source... Go to PubMed...
  58. Reynolds Risk Score [Internet]. Reynolds Risk Score; 2012 [cited 2013 Apr 20]. Available from: http://www.reynoldsriskscore.org/.
  59. Gaziano TA, Young CR, Fitzmaurice G, Atwood S, Gaziano JM. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort. Lancet. 2008 Mar 15;371(9616):923-31. Go to original source... Go to PubMed...
  60. Sacco RL, Khatri M, Rundek T, Xu Q, Gardener H, Boden-Albala B, et al. Improving global vascular risk prediction with behavioral and anthropometric factors. The multiethnic NOMAS (Northern Manhattan Cohort Study). J Am Coll Cardiol. 2009 Dec 8;54(24):2303-11. Go to original source... Go to PubMed...
  61. University of Miami, Miller School of Medicine, Department of Neurology. Global Vascular Risk Score Calculator [Internet]. Miami: University of Miami; 2008 [cited 2013 Apr 20]. Available from: http://neurology.med.miami.edu/gvr/.
  62. NIPPON DATA80 Research Group. Risk assessment chart for death from cardiovascular disease based on a 19-year follow-up study of a Japanese representative population. Circ J. 2006 Oct;70(10):1249-55. Go to original source...
  63. Zhang XF, Attia J, D'Este C, Yu XH, Wu XG. A risk score predicted coronary heart disease and stroke in a Chinese cohort. J Clin Epidemiol. 2005 Sep;58(9):951-8. Go to original source... Go to PubMed...
  64. Kang GD, Guo L, Guo ZR, Hu XS, Wu M, Yang HT. Continuous metabolic syndrome risk score for predicting cardiovascular disease in the Chinese population. Asia Pac J Clin Nutr. 2012;21(1):88-96.
  65. US Preventive Services Task Force.Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009 Mar 17;150(6):396-404. Go to original source...
  66. Waldron CA, van der Weijden T, Ludt S, Gallacher J, Elwyn G. What are effective strategies to communicate cardiovascular risk information to patients?Asystematic review. Patient Educ Couns. 2011 Feb;82(2):16981. Go to original source... Go to PubMed...
  67. Wells S, Furness S, Rafter N, Horn E, Whittaker R, Stewart A, et al. Integrated electronic decision support increases cardiovascular disease risk assessment four fold in routine primary care practice. Eur J Cardiovasc Prev Rehabil. 2008 Apr;15(2):173-8. Go to original source... Go to PubMed...