There is uncertainty whether current strategies for providing CVD risk scores  affect CVD events .
Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm .
BACKGROUND The current paradigm for cardiovascular disease ( CVD ) emphasises absolute risk assessment to guide treatment decisions in primary prevention .
Although the derivation and validation of multivariable risk assessment tools , or CVD risk scores , have attracted considerable attention , their effect on clinical outcomes is uncertain .
OBJECTIVES To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes , risk factor levels , preventive medication prescribing , and health behaviours .
From hypertension control to global cardiovascular risk management: an educational intervention in a cluster-randomised controlled trial
Background Guidelines on hypertension management recommend adjusting therapeutic efforts in accordance with global cardiovascular risk ( CVR ) rather than by blood pressure levels alone . However , this paradigm change has not yet arrived in German General Practice . We have evaluated the effect of an educational outreach visit with general practitioners ( GPs ) , encouraging them to consider CVR in treatment decisions for patients with hypertension . Methods Prospect i ve cluster-r and omised trial comprising 3443 patients with known hypertension treated by 87 GPs . Practice s were r and omly assigned to complex ( A ) or simple ( B ) intervention . Both groups received a guideline by mail ; group A also received complex peer intervention promoting the concept of global CVR . Clinical data were collected at baseline and 6 - 9 months after intervention . Main outcome was improvement of calculated CVR in the predefined sub population of patients with a high CVR ( 10-year mortality ≥5 % ) , but no manifest cardiovascular disease . Results Adjusted for baseline the follow-up CVR were 13.1 % ( 95 % CI 12.6%-13.6 % ) ( A ) and 12.6 % ( 95 % CI 12.2%-13.1 % ) ( B ) with a group difference ( A vs. B ) of 0.5 % ( -0.2%-1.1 % ) , p = 0.179 . The group difference was -0.05 % in patients of GPs familiar with global CVR and 1.1 % in patients of GPs not familiar with with global CVR . However , this effect modification was not significant ( p = 0.165 ) . Pooled over groups , the absolute CVR reduction from baseline was 1.0 % , p < 0.001 . The ICC was 0.026 ( p = 0.002 ) . Hypertension control ( BP < 140/90 mmHg ) improved in the same sub population from 38.1 to 45.9 % in the complex intervention group , and from 35.6 to 46.5 % in the simple intervention group , with adjusted follow-up control rates of 46.7 % ( 95 % CI 40.4%-53.1 % ) ( A ) and 46.9 % ( 95 % CI 40.3%-53.5 % ( B ) and an adjusted odds ratio ( A vs B ) of 0.99 ( 95 % CI 0.68 - 1.45 ) , p = 0.966 . Conclusions Our complex educational intervention , including a clinical outreach visit , had no significant effect on CVR of patients with known hypertension at high risk compared to a simple postal intervention . Trial registration IS RCT N44478543
There is uncertainty whether current strategies for providing CVD risk scores  affect CVD events .
Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm .
BACKGROUND The current paradigm for cardiovascular disease ( CVD ) emphasises absolute risk assessment to guide treatment decisions in primary prevention .
Although the derivation and validation of multivariable risk assessment tools , or CVD risk scores , have attracted considerable attention , their effect on clinical outcomes is uncertain .
OBJECTIVES To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes , risk factor levels , preventive medication prescribing , and health behaviours .