The National Heart Foundation of New Zealand has published tables for predicting cardiovascular risk based on the Framingham study. The risk can help the physician and patient select lifestyle changes or therapy for prevention of cardiovascular events.
Cardiovascular event:
(1) death related to coronary artery disease
(2) nonfatal myocardial infarction
(3) new onset of angina
(4) fatal or nonfatal stroke
(5) transient ischemic attack
(6) development of congestive heart failure
(7) development of peripheral vascular disease
Risk factors for cardiovascular events:
(1) diabetes mellitus: (a) someone taking insulin or (b) oral hypoglycemic agent or (c) fasting blood glucose concentration > 8.0 mmol/L (> 144 mg/dL)
(2) blood pressure: as determined by taking the mean of 2 readings on each of 2 occasions (this is sufficient for assessing risk but not for establishing a pretreatment baseline)
(3) ratio of total cholesterol to HDL cholesterol: as determined by (a) taking the mean of 2 non-fasting Reflotron measurements or (b) one nonfasting laboratory measurement (this is sufficient for assessing risk but not for establishing a pretreatment baseline)
(4) smoking cigarettes: regular daily cigarette smoking, or having stopped in the previous 12 months
(5) age in years
People at high risk (> 20%) for cardiovascular event in next 5 years based on clinical findings:
(1) current symptomatic cardiovascular disease (one or more of conditions listed above)
(2) left ventricular hypertrophy on electrocardiography
(3) previous angioplasty or coronary artery bypass graft
(4) genetic or familial lipid disorders
(5) diabetic nephropathy with albuminuria > 300 mg/day
Other risk factors not listed in the charts which may influence treatment decisions for patients at borderline treatment levels:
(1) family history of cardiovascular disease
(2) physical inactivity
(3) obesity
(4) left ventricular hypertrophy on echocardiography
Drug treatment:
(1) reduces the relative risk of cardiovascular events in groups of patients with blood pressure > 150 mm Hg systolic, or > 90 mm Hg diastolic, or > 5 mmol/L total cholesterol;
(2) the combined cardiovascular morbidity and mortality risk is reduced by about one third if there is reduction in systolic blood pressure of 10-15 mm Hg, diastolic blood pressure of 5-8 mm Hg, or 20% in total cholesterol.
Reading Tables
(1) There are 32 tables in 8 clusters (4 age, 2 gender, 2 diabetes, 2 smoking).
(2) Determine gender (male or female), diabetes status (present or absent), and smoking status (smoker or nonsmoker) for cluster selection.
(3) Identify age for table selection.
|
patient age in years |
age for tables |
|
>= 35 to < 45 |
40 |
|
>= 45 to < 55 |
50 |
|
>= 55 to < 65 |
60 |
|
>= 65 to <= 75 |
70 |
(4) Identify total cholesterol to HDL cholesterol ratio for column selection.
|
total to HDL cholesterol ratio |
ratio for column in tables |
|
>= 3.5 to < 4.5 |
4 |
|
>= 4.5 to < 5.5 |
5 |
|
>= 5.5 to < 6.5 |
6 |
|
>= 6.5 to < 7.5 |
7 |
|
>= 7.5 to < 8.5 |
8 |
(5) Identify blood pressure for row selection.
(6) Read Risk Level from table cell identified.
Risk Level and Treatment Benefit
|
Risk Level |
5 Year Risk |
Risk |
Benefit 1 |
Benefit 2 |
|
1 |
< 2.5% |
mild |
< 0.8 |
> 125 |
|
2 |
2.5 - 5% |
mild |
1.25 |
80 |
|
3 |
5 - 10% |
mild |
2.5 |
40 |
|
4 |
10 - 15% |
moderate |
4 |
25 |
|
5 |
15 - 20% |
high |
6 |
16 |
|
6 |
20 - 25% |
very high |
7.5 |
13 |
|
7 |
25 - 30% |
very high |
9 |
11 |
|
8 |
> 30% |
very high |
> 10 |
< 10 |
where:
• 5 year risk indicates risk for non-fatal and fatal cardiovascular event in next 5 years
• Cardiovascular events are reduced by one third over a 5 year period with either a 20% reduction of total cholesterol or a 10-15 mm Hg reduction in systolic blood pressure or a 5-8 mm Hg reduction in systolic pressure.
• benefit 1 = 0.33 * (5 year risk)
• benefit 1 = cardiovascular events prevented per 100 persons treated for 5 years
• benefit 2 = number needed to treat for 5 years to prevent 1 event
• benefit 2 = 100 / (benefit 1)
For people > 75 years, the absolute risk of cardiovascular disease in the next 5 years is > 15% in most people.
Limitations: The risk charts may underestimate true risk if
(1) the total cholesterol concentration is > 8.0 – 9.0 mmol/L
(2) the ratio of total cholesterol to HDL cholesterol is > 8.0 – 9.0
(3) the blood pressure is > 170-180 mm Hg for systolic and > mm Hg 100-105 for diastolic
Male, No Diabetes, Nonsmoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
2 |
3 |
3 |
3 |
3 |
|
160/95 |
2 |
2 |
2 |
3 |
3 |
|
140/85 |
1 |
1 |
2 |
2 |
2 |
|
120/75 |
1 |
1 |
1 |
1 |
2 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
3 |
4 |
4 |
4 |
5 |
|
160/95 |
3 |
3 |
3 |
4 |
4 |
|
140/85 |
2 |
3 |
3 |
3 |
3 |
|
120/75 |
2 |
2 |
2 |
3 |
3 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
4 |
5 |
5 |
6 |
6 |
|
160/95 |
4 |
4 |
5 |
5 |
5 |
|
140/85 |
3 |
4 |
4 |
4 |
5 |
|
120/75 |
3 |
3 |
3 |
3 |
4 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
6 |
7 |
7 |
8 |
8 |
|
160/95 |
5 |
6 |
6 |
7 |
7 |
|
140/85 |
4 |
5 |
5 |
6 |
6 |
|
120/75 |
3 |
4 |
4 |
5 |
5 |
Male, No Diabetes, Smoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
3 |
4 |
4 |
4 |
5 |
|
160/95 |
3 |
3 |
3 |
4 |
4 |
|
140/85 |
2 |
3 |
3 |
3 |
3 |
|
120/75 |
2 |
2 |
2 |
3 |
3 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
5 |
5 |
6 |
6 |
7 |
|
160/95 |
4 |
5 |
5 |
5 |
6 |
|
140/85 |
3 |
4 |
4 |
4 |
5 |
|
120/75 |
3 |
3 |
3 |
4 |
4 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
6 |
7 |
8 |
8 |
8 |
|
160/95 |
6 |
6 |
7 |
7 |
8 |
|
140/85 |
5 |
5 |
6 |
6 |
7 |
|
120/75 |
4 |
4 |
5 |
5 |
5 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
8 |
8 |
8 |
8 |
8 |
|
160/95 |
7 |
8 |
8 |
8 |
8 |
|
140/85 |
6 |
7 |
7 |
8 |
8 |
|
120/75 |
5 |
6 |
6 |
7 |
7 |
Male, Diabetes, Nonsmoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
3 |
3 |
4 |
4 |
4 |
|
160/95 |
3 |
3 |
3 |
3 |
4 |
|
140/85 |
2 |
2 |
3 |
3 |
3 |
|
120/75 |
1 |
2 |
2 |
2 |
2 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
4 |
5 |
5 |
6 |
6 |
|
160/95 |
4 |
4 |
5 |
5 |
5 |
|
140/85 |
3 |
3 |
4 |
4 |
4 |
|
120/75 |
3 |
3 |
3 |
3 |
4 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
6 |
7 |
7 |
8 |
8 |
|
160/95 |
5 |
6 |
6 |
7 |
7 |
|
140/85 |
4 |
5 |
5 |
6 |
6 |
|
120/75 |
3 |
4 |
4 |
5 |
5 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
8 |
8 |
8 |
8 |
8 |
|
160/95 |
7 |
7 |
8 |
8 |
8 |
|
140/85 |
6 |
6 |
7 |
7 |
8 |
|
120/75 |
5 |
5 |
6 |
6 |
6 |
Male, Diabetes, Smoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
4 |
5 |
5 |
6 |
6 |
|
160/95 |
4 |
4 |
4 |
5 |
5 |
|
140/85 |
3 |
3 |
4 |
4 |
4 |
|
120/75 |
3 |
3 |
3 |
3 |
4 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
6 |
7 |
8 |
8 |
8 |
|
160/95 |
5 |
6 |
7 |
7 |
7 |
|
140/85 |
4 |
5 |
6 |
6 |
6 |
|
120/75 |
4 |
4 |
4 |
5 |
5 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
8 |
8 |
8 |
8 |
8 |
|
160/95 |
7 |
8 |
8 |
8 |
8 |
|
140/85 |
6 |
7 |
7 |
8 |
8 |
|
120/75 |
5 |
6 |
6 |
7 |
7 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
8 |
8 |
8 |
8 |
8 |
|
160/95 |
8 |
8 |
8 |
8 |
8 |
|
140/85 |
8 |
8 |
8 |
8 |
8 |
|
120/75 |
7 |
7 |
8 |
8 |
8 |
Female, No Diabetes, Nonsmoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
2 |
2 |
2 |
3 |
3 |
|
160/95 |
1 |
2 |
2 |
2 |
2 |
|
140/85 |
1 |
1 |
1 |
2 |
2 |
|
120/75 |
1 |
1 |
1 |
1 |
1 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
3 |
3 |
3 |
3 |
4 |
|
160/95 |
2 |
3 |
3 |
3 |
3 |
|
140/85 |
2 |
2 |
2 |
3 |
3 |
|
120/75 |
1 |
1 |
2 |
2 |
2 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
3 |
4 |
4 |
5 |
5 |
|
160/95 |
3 |
3 |
4 |
4 |
4 |
|
140/85 |
2 |
3 |
3 |
3 |
3 |
|
120/75 |
2 |
2 |
2 |
3 |
3 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
4 |
5 |
5 |
6 |
6 |
|
160/95 |
4 |
4 |
4 |
5 |
5 |
|
140/85 |
3 |
3 |
4 |
4 |
4 |
|
120/75 |
3 |
3 |
3 |
3 |
3 |
Female, No Diabetes, Smoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
3 |
3 |
3 |
4 |
4 |
|
160/95 |
2 |
3 |
3 |
3 |
3 |
|
140/85 |
2 |
2 |
3 |
3 |
3 |
|
120/75 |
1 |
2 |
2 |
2 |
2 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
4 |
4 |
5 |
5 |
5 |
|
160/95 |
3 |
4 |
4 |
4 |
5 |
|
140/85 |
3 |
3 |
3 |
4 |
4 |
|
120/75 |
2 |
3 |
3 |
3 |
3 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
5 |
6 |
6 |
6 |
7 |
|
160/95 |
4 |
5 |
5 |
6 |
6 |
|
140/85 |
4 |
4 |
4 |
5 |
5 |
|
120/75 |
3 |
3 |
4 |
4 |
4 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
6 |
7 |
7 |
8 |
8 |
|
160/95 |
5 |
6 |
6 |
7 |
7 |
|
140/85 |
4 |
5 |
5 |
6 |
6 |
|
120/75 |
4 |
4 |
4 |
5 |
5 |
Female, Diabetes, Nonsmoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
3 |
3 |
4 |
4 |
4 |
|
160/95 |
3 |
3 |
3 |
3 |
4 |
|
140/85 |
2 |
2 |
3 |
3 |
3 |
|
120/75 |
1 |
2 |
2 |
2 |
3 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
4 |
5 |
5 |
5 |
6 |
|
160/95 |
4 |
4 |
4 |
5 |
5 |
|
140/85 |
3 |
3 |
4 |
4 |
4 |
|
120/75 |
2 |
3 |
3 |
3 |
3 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
5 |
6 |
7 |
7 |
7 |
|
160/95 |
5 |
5 |
6 |
6 |
6 |
|
140/85 |
4 |
4 |
5 |
5 |
5 |
|
120/75 |
3 |
3 |
4 |
4 |
4 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
7 |
7 |
8 |
8 |
8 |
|
160/95 |
6 |
6 |
7 |
7 |
8 |
|
140/85 |
5 |
5 |
6 |
6 |
7 |
|
120/75 |
4 |
4 |
5 |
5 |
5 |
Female, Diabetes, Smoker
|
age 40 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
4 |
5 |
5 |
6 |
6 |
|
160/95 |
4 |
4 |
5 |
5 |
5 |
|
140/85 |
3 |
3 |
4 |
4 |
4 |
|
120/75 |
3 |
3 |
3 |
3 |
4 |
|
age 50 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
6 |
7 |
7 |
8 |
8 |
|
160/95 |
5 |
6 |
6 |
7 |
7 |
|
140/85 |
4 |
5 |
5 |
6 |
6 |
|
120/75 |
3 |
4 |
4 |
5 |
5 |
|
age 60 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
8 |
8 |
8 |
8 |
8 |
|
160/95 |
7 |
7 |
8 |
8 |
8 |
|
140/85 |
6 |
6 |
7 |
7 |
8 |
|
120/75 |
4 |
5 |
6 |
6 |
6 |
|
age 70 |
ratio of total cholesterol to HDL-cholesterol |
||||
|
blood pressure |
4 |
5 |
6 |
7 |
8 |
|
180/105 |
8 |
8 |
8 |
8 |
8 |
|
160/95 |
8 |
8 |
8 |
8 |
8 |
|
140/85 |
7 |
8 |
8 |
8 |
8 |
|
120/75 |
6 |
6 |
7 |
7 |
8 |
Purpose: To use the updated New Zealand cardiovascular risk tables to identify and treat patients at risk for cardiovascular disease.
Specialty: Cardiology
Objective: risk factors, severity, prognosis, stage
ICD-10: I20, I21, I25,
