Hormonal replacement therapy in postmenopausal women can have both beneficial and deleterious effects. Col et al used a Markov model to develop tables determining the risk a woman may have for developing coronary heart disease, breast cancer and/or hip fracture. These risks can help a woman decide how hormonal replacement might affect her.
Risk Weight for Lifetime Risk of Coronary Heart Disease
Coronary heart disease includes myocardial infarction, angina pectoris, unstable angina and sudden cardiac death. The risk weights are based on the Framingham Heart Study and Framingham Offspring Cohorts.
|
Parameter |
Finding |
Risk Weight |
|---|---|---|
|
systolic blood pressure |
100 mm Hg |
0 |
|
|
120 mm Hg |
0.17 |
|
|
140 mm Hg |
0.31 |
|
|
160 mm Hg |
0.43 |
|
|
180 mm Hg |
0.54 |
|
total cholesterol to HDL cholesterol ratio |
2 |
0 |
|
|
4 |
0.49 |
|
|
6 |
0.79 |
|
|
8 |
0.99 |
|
|
10 |
1.15 |
|
left ventricular hypertrophy on electrocardiogram |
yes |
0.59 |
|
|
no |
0 |
|
history of diabetes mellitus |
yes |
0.38 |
|
|
no |
0 |
|
cigarette smoking |
yes |
0.28 |
|
|
no |
0 |
where:
• The impact of any antihypertensive medication on systolic blood pressure was not covered.
• Cigarette smoking: not stated as ever vs recent vs current.
The points for systolic blood pressure and the cholesterol ratio are not stated as discrete or continuous. Equations developed in JMP are:
points for systolic blood pressure =
= (-0.000025 * ((systolic blood pressure) ^ 2)) + (0.0137 * (systolic blood pressure)) – 1.118
points for total cholesterol to HDL cholesterol ratio =
= (-0.01357 * ((ratio) ^ 2)) + (0.30286 * (ratio)) – 0.536
risk weight for coronary heart disease =
= SUM(points for all 5 risk factors)
Risk Weight for Lifetime Risk of Breast Cancer
Breast cancer includes both in situ and invasive forms. The risk weighs were based on the Breast Cancer Detection Demonstration Project.
|
Parameter |
Finding |
Risk Weight |
|---|---|---|
|
age at menarche |
< 12 years |
0.20 |
|
|
12 – 13 years |
0.10 |
|
|
> 13 years |
0.01 |
|
number of previous benign breast biopsies |
0 |
0 |
|
|
1 |
0.24 |
|
|
>=2 |
0.48 |
|
age at first life birth and first degree relatives with breast cancer |
age: < 20 first degree relatives: 0 |
0 |
|
|
age: < 20 first degree relatives: 1 |
0.96 |
|
|
age: < 20 first degree relatives: >= 2 |
1.92 |
|
|
age: 20 - 24 first degree relatives: 0 |
0.22 |
|
|
age: 20 - 24 first degree relatives: 1 |
0.99 |
|
|
age: 20 - 24 first degree relatives: >= 2 |
1.75 |
|
|
age: 25 - 29 first degree relatives: 0 |
0.44 |
|
|
age: 25 - 29 first degree relatives: 1 |
1.01 |
|
|
age: 25 - 29 first degree relatives: >= 2 |
1.59 |
|
|
age: >= 30 first degree relatives: 0 |
0.66 |
|
|
age: >= 30 first degree relatives: 1 |
1.04 |
|
|
age: >= 30 first degree relatives: >= 2 |
1.43 |
|
|
nulliparous first degree relatives: 0 |
0.44 |
|
|
nulliparous first degree relatives: 1 |
1.01 |
|
|
nulliparous first degree relatives: >= 2 |
1.59 |
where:
• A nulliparous patient has the same risk as the woman with a first life birth when 25-29.
risk weight for breast cancer =
= SUM(points for all 3 risk factors)
Risk Weight for Lifetime Risk of Hip Fracture
The risk weight for hip fracture is based on the Study of Osteoporotic Fractures Research Group.
|
Parameter |
Finding |
Risk Weight |
|---|---|---|
|
history of maternal hip fracture |
yes |
1 |
|
|
no |
0 |
|
history of previous hyperthyroidism |
yes |
1 |
|
|
no |
0 |
|
current use of long-acting benzodiazepines |
yes |
1 |
|
|
no |
0 |
|
number of hours on feet per day |
<= 4 hours |
1 |
|
|
> 4 hours |
0 |
|
able to rise from chair |
yes |
0 |
|
|
no |
1 |
|
resting pulse rate |
> 80 beats per minute |
1 |
|
|
<= 80 beats per minute |
0 |
|
height at age 25 years |
<= 165 cm |
0 |
|
|
> 165 |
1 point for each 6 cm > 165 cm |
|
self-rated health |
excellent |
0 |
|
|
good |
0 |
|
|
fair |
1 |
|
|
poor |
2 |
|
change in weight since age 25 years |
increased |
0 |
|
|
decreased 0-19% |
0 |
|
|
decreased 20-40% |
1 |
|
|
decreased 41-60% |
2 |
|
calcaneal bone density |
at mean or greater |
0 |
|
|
decreased |
1 point for each SD below mean |
where:
• The points for height are to increase 1 point for each 6 cm above 165 cm at age 25 years. It is not stated if this is continuous or discrete (viz, 1.5 points for 174 cm, 1 point for 166-171)
• I am assuming that a person with more than a 60% drop in weight from age 25 would be given 2 points.
• The points for calcaneal bone density are to increase for each SD below the mean. This does not specify if this is rounded or set at each integer change in SD or based on the number of absolute SD below the mean.
• Since the risk weights for hip fracture are integers, I will provide discrete integer values rather than continuous values. An alternative approach would be to round the values for height and calcaneal bone density.
risk weight for hip fracture =
= SUM(points for all 10 risk factors)
Specialty: Obstetrics & Gynecology, Pharmacology, clinical
