When to remeasure cardiovascular risk in untreated people at low and intermediate risk: observational study.
Pubmed ID: 23553971
Journal: BMJ (Clinical research ed.)
Publication Date: 04/03/2013
Affiliation: Centre for Research in Evidence Based Practice, Bond University, QLD 4229, Australia.
MeSH Terms: Humans, Male, Adult, Female, Cardiovascular Diseases, Risk Factors, United States, Cohort Studies, Middle Aged, Risk Assessment, Blood Pressure, Disease Progression, Practice Guidelines as Topic, Cholesterol, Observation, Diagnostic Techniques, Cardiovascular, Epidemiological Monitoring, Tokyo
Authors: Hayen A, Irwig L, Bell KJ, Takahashi O, Ohde S, Glasziou P
Cite As: Bell KJ, Hayen A, Irwig L, Takahashi O, Ohde S, Glasziou P. When to remeasure cardiovascular risk in untreated people at low and intermediate risk: observational study. BMJ 2013 Apr 3;346:f1895.
OBJECTIVE: To estimate the probability of becoming high risk for cardiovascular disease among people at low and intermediate risk and not being treated for high blood pressure or lipid levels. DESIGN: Observational study. SETTING: General communities in Japan and the United States. PARTICIPANTS: 13,757 participants of the Tokyo health check-up study and 3855 of the Framingham studies aged 30-74 years with complete data on risk equation covariates, not receiving blood pressure or cholesterol lowering treatment, and with an estimated risk of cardiovascular disease <20% within 10 years. We stratified participants on the basis of baseline risk: <5%, 5-<10%, 10-<15%, and 15-<20%.We used follow-up measurements from the Tokyo study done annually over three years (2006-10) and follow-up visits in the Framingham study done between eight (1968-75) and 19 years (1990-1995) after baseline. MAIN OUTCOME MEASURE: Estimated 10 year risk of a cardiovascular event >20% using the Framingham equation. RESULTS: At baseline most participants had <5% risk (60.6% of Tokyo cohort and 45.7% of Framingham cohort) or 5-<10% risk (24.0% and 28.0%, respectively) of a cardiovascular event within 10 years. There was <10% probability of crossing the treatment threshold at 19, 8, and 3 years for baseline risk groups <5%, 5-<10%, and 10-<15%, respectively, and >10% probability of crossing the treatment threshold at one year for the 15-<20% baseline risk group. CONCLUSIONS: Decisions on the frequency of remeasuring for cardiovascular risk should be made on the basis of baseline risk. Repeat risk estimation before 8-10 years is not warranted for most people initially not requiring treatment. However, remeasurement within a year seems warranted in those with an initial 15-<20% risk.