# Presentation: 543803

## Cardiovascular Disease in WomenModule III: Risk Assessment Tool

## Risk Stratification: 

**CHD equivalent**
- Diabetes mellitus
- Established atherosclerotic disease
- Includes many patients with chronic kidney disease, especially ESRD
**Major Risk Factors:**
- Age _>_ 55 years
- Smoking
- Hypertension, whether or not treated with medication
- HDL cholesterol < 40mg/dL (HDL cholesterol ≥ 60mg/dL is a negative risk factor)
- Family history of premature CVD

**     ****Source: **Mosca  2004, ATP III 2002

**Notes:**
SLIDE INFORMATION SOURCES:  Mosca L, et al.  Evidence-based guidelines for cardiovascular disease prevention in women.  Circulation 2004; 109:672-693.; Third Report of the National Cholesterol Education Program (NCEP) Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), NIH, NHLBI, 2002.

## Risk Stratification

**Diabetes**
- Automatically places a patient in a “High Risk” category
**Family History**
- Defined as CVD in a female first degree relative < 65 years old, or a first degree male relative < 55 years old

**     ****Source: **Mosca  2004

**Notes:**
SLIDE INFORMATION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693.

## Risk Stratification

- Calculate 10 year risk for all patients with two or more risk factors that do not already meet criteria for CHD equivalent
- Use electronic calculator for most precise estimate:  www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

**     ****Source: **Mosca 2004

**Notes:**
SLIDE INFORMSTION SOURCE:  Mosca L, et al.  Evidence-based guidelines for cardiovascular disease prevention in women.  Circulation 2004; 109:672-693.

## CHD Risk Equivalents

**High Risk > 20% 10-yr risk for CHD events**
- Established coronary artery disease
- Carotid artery stenosis
- Peripheral arterial disease
- Abdominal aortic aneurysm
- Diabetes
- Includes many patients with chronic renal disease, especially ESRD

**     ****Source: **Mosca 2004

**Notes:**
SLIDE INFORMATION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693.

High risk patients have a greater than 20% 10-year risk of CHD events based on Framingham data. Among patients with chronic renal disease, those with end stage renal disease are at particular risk (1)

(1) Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693.

## Risk Stratification

**Intermediate Risk 10-20% 10-yr risk for CHD events**
- May include women with metabolic syndrome, especially women over the age of 60 or with individual factors that are markedly elevated or severe
- Often includes women with multiple risk factors, a single markedly elevated risk factor, or a 1st degree relative with premature CVD
- May include women with subclinical cardiovascular disease (elevated coronary calcium score)- this is not included in Framingham risk calculations
**Use electronic calculator for most precise estimate: www.nhlbi.nih.gov/guidelines/cholesterol/index.htm**

**     ****Source: **Mosca 2004

**Notes:**
SLIDE INFORMATION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693.

Most patients in the intermediate category of risk will have two or more risk factors (1).
Routine evaluation of coronary calcium by electron-beam computed tomography (EBCT) is not recommended (2).
Women at higher levels of intermediate risk should be treated more aggressively (3)

(1)Third Report of the National Cholesterol Education Program (NCEP) Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel III), NIH, NHLBI, 2002
(2)O’Rourke RA, et al. American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol, 2000;36(1):326-340.
(3)Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693.

## Risk Stratification

**Lower Risk <10% 10-yr risk for CHD events**
- May include women with one or more risk factors
- May include women with defined metabolic syndrome, if no individual factor is severe or markedly elevated
- May include women with no risk factors, but non-optimal lifestyle factors, such as lack of regular exercise or a high fat diet
**Optimal Risk <10% 10-yr risk for CHD events**
- Optimal levels of risk factors
- Heart healthy lifestyle

**     ****Source: **Mosca 2004

**Notes:**
SLIDE INFORMATION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693.

## Risk Stratification

**An online calculator is available at:****www.nhlbi.nih.gov/guidelines/cholesterol/index.htm**

**     ****Source: **NHLBI 2005

##      Source: http://www.nhlbi.nih.gov/about/framingham/riskabs.htm

**     ****Source: **http://www.nhlbi.nih.gov/about/framingham/riskabs.htm

##      Source: http://www.nhlbi.nih.gov/about/framingham/riskabs.htm

**     ****Source: **http://www.nhlbi.nih.gov/about/framingham/riskabs.htm

## Downloadable Scoring Sheet for 10-year CHD event risk

**The scoring sheet is available at: www.nhlbi.nih.gov/about/framingham/riskabs.htm**

**     ****Source: **www.nhlbi.nih.gov/about/framingham/riskabs.htm

- Final May 2006

**Notes:**
SLIDE INFORMATION SOURCE: www.nhlbi.nih.gov/about/framingham/riskabs.htm, accessed April 6, 2005.