Prevention of cardiovascular diseases: focus on modifiable cardiovascular risk

To determine whether the use of a 20% absolute risk threshold for cardiovascular disease as recommended in current guidelines leads to exclusion of patients with a substantial modifiable risk (> or = 5%).

Data collected within the framework of a randomised controlled trial in three primary health care centres located in deprived neighbourhoods were analysed. The 10 year absolute risk and the modifiable part of risk were calculated by using the Framingham risk equation. Among patients with a modifiable risk reduction of > or = 5% (number needed to treat < or = 20) the characteristics and risk factors of patients with an absolute risk > or = 20% and those with an absolute risk < 20% were compared.

293 patients aged 30-70 years at risk of developing cardiovascular disease were included, of whom 66% were women and 36% were of Dutch origin. Of all patients, 33% had an absolute risk > or = 20% and 61% had a modifiable risk > or = 5%. Of those at > or = 20% absolute risk, a vast majority (98%) had a modifiable risk > or = 5%. Among those with an absolute risk < 20%, 43% had a modifiable risk > or = 5%; this group, who were relatively young and predominantly women, constituted 29% of the entire study population.

Targeting preventive strategies at a 10 year absolute risk > or = 20% leads to exclusion of a large group of relatively young, predominantly female patients. In total, about one quarter had an absolute risk < 20% but a modifiable risk > or = 5% and should therefore benefit from intervention.