Elsevier

Journal of Clinical Lipidology

Volume 5, Issue 3, May–June 2011, Pages 166-172
Journal of Clinical Lipidology

Original Article
The population effects of the global cardiovascular risk model in United States Adults: Findings from the National Health and Nutrition Surveys, 2005–2006

https://doi.org/10.1016/j.jacl.2011.02.007Get rights and content

Background

The Framingham Global Cardiovascular Disease (FRS-CVD) risk assessment is a proposed alternative for the assessment of hard coronary heart disease (FRS-CHD) event risk. Beyond heart attack and death, FRS-CVD risk adds the end points of cerebrovascular disease, angina, heart failure, and peripheral vascular disease.

Objective

We sought to estimate the population impact of using FRS-CVD instead of FRS-CHD risk prediction on U.S. adults.

Methods

We analyzed FRS-CHD and FRS-CVD risk in men age 45–74 and women age 55–74 without cardiovascular disease or diabetes, using the National Health and Nutrition Examination Survey 2005–2006. We stratified the population into 10-year risk categories: low: <6%, moderate ≥6 to <10%, moderate high ≥10 to <20%, and high ≥20% by both risk models, and assessed change in risk category distribution and achievement of lipid goals.

Results

We analyzed 1020 subjects who statistically represent approximately 50 million U.S. adults. When the FRS-CVD was used, we found that 63% of men and 74% of women increase at least one risk category compared with when the FRS-CHD is used. Overall, the low-risk population decreases from 52% to 16% and the high-risk group increases from 4% to 20%. Of the subjects changing risk categories, 30% will now fail to meet their new corresponding lipid goals.

Conclusions

FRS-CVD end points are more comprehensive, yet the population implications of such a change may be profound. The use of a FRS-CVD risk model significantly increases the intermediate and high-risk groups, thus increasing the number of individuals eligible for novel risk assessment tools such as high-sensitivity C-reactive protein, coronary calcium scoring, and more frequent use of pharmacotherapy.

Section snippets

Methods

The National Center for Health Statistics performs the National Health and Nutrition Examination Survey (NHANES) surveys7 in 2-year increments with the objective being to define the health and nutritional status of the United States population. The NHANES surveys are composed of a home health interview and a health examination that is performed in a mobile exam center (MEC). Participants undergo a home interview process administered by a trained interviewer. Subsequently, participants undergo

Men

A total of 663 men representing 32.8 million U.S. men ages 45–74 met inclusion criteria. The mean age of the included men was 55.1 years (SD 7.9 years), mean LDL-C was 120.3 mg/dL (SD 37.3), mean systolic blood pressure was 125.4 mmHg (SD 16.1 mmHg), mean diastolic blood pressure was 73.8 mmHg (SD 11.2 mmHg), mean HDL was 50.5 mg/dL (SD 14.6 mg/dL), and the mean total cholesterol was 204.9 mg/dL (SD 36.2 mg/dL). Of the included male subjects, 26% were tobacco users, 16% had a positive family

Primary findings

The present cross-sectional analysis represents the first report to define risk reclassification distributions and corresponding changes to lipid goal achievements clinicians will encounter if they shift their risk assessment practice from the FRS-CHD to the FRS-CVD for routine cardiovascular risk assessment. Overall there were three significant findings. First, we found with the routine use of the FRS-CVD model nearly two-thirds (63%) of U.S. men aged 45–74 and three-quarters (74%) of U.S.

Conclusions

It remains uncertain whether the ATP IV writing group will continue to recommend multivariate risk assessment, and if so, which risk assessment model should be used. Clinicians, however, should be aware that shifting nationally to routine calculation of global CVD risk does have implications. Use of the FRS-CVD risk assessment model greatly increases both the number of individuals classified as “intermediate risk” (FRS between 6% and 20%), and high risk (FRS ≥20%) while markedly decreasing the

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