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Primary prevention of cardiovascular disease using validated risk scores: a systematic review
Andrew Willis1, Melanie Davies, Thomas Yates
1Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK. aw187@le.ac.uk
Insights
Validated cardiovascular disease (CVD) risk scores show potential for primary prevention. However, current multifactorial interventions often lack the intensity needed to significantly reduce CVD risk or mortality.
Area of Science:
- Public Health
- Epidemiology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) poses a significant public health challenge in the UK, with high prevalence and treatment costs.
- Primary prevention strategies increasingly utilize validated CVD risk scores to identify high-risk individuals.
Purpose of the Study:
- To review the current evidence on the effectiveness of using validated CVD risk scores for the primary prevention of CVD.
- To evaluate the impact of this strategy on reducing CVD risk and mortality.
Main Methods:
- A comprehensive literature search was conducted across MEDLINE, EMBASE, and the Cochrane database.
- Expert opinions and reference lists of relevant studies were also consulted.
- Due to heterogeneity in outcomes and risk scores, a meta-analysis was not feasible.
Main Results:
- Sixteen papers reporting five unique trials were identified.
- Only one study showed a significant difference in risk score, and another reported a significant difference in total mortality.
- Most studies reported significant differences in individual risk factors.
Conclusions:
- Multifactorial interventions targeting individuals identified by CVD risk scores hold potential for reducing CVD risk and mortality.
- However, the intensity of interventions in current studies is often insufficient to achieve significant reductions in CVD mortality or validated CVD risk.
Objectives:
The high prevalence of cardiovascular disease (CVD) and the increased cost of treatment have prompted strategies for the primary prevention of CVD in the UK to move towards the use of validated CVD risk scores to identify individuals at the highest risk. There are no reviews evaluating the effectiveness of this strategy as a means of reducing CVD risk or mortality. This review summarizes current evidence for and against the use of validated CVD risk scores for the primary prevention of CVD.
Design:
We utilized an in depth search strategy to search MEDLINE, EMBASE and the Cochrane database of clinical trials, expert opinions were sought and reference lists of identified studies and relevant reviews were checked. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies.
Setting:
The majority of included trials were carried out in a primary care setting. 2 trials were carried out in North America, 2 in Scandinavia and 1 in the UK.
Participants:
31,651 participants in total were recruited predominantly from a primary care setting. Participants were aged 18-65 years old and were free from CVD at baseline.
Main Outcome Measures:
Outcome measures used in the included studies were change in validated CVD risk score and CVD/All-cause mortality.
Results:
We identified 16 papers which matched the inclusion criteria reporting 5 unique trials. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. Only one study reported a significant difference in risk score at follow up and one study reported a significant difference in total mortality, however significant differences in individual risk factors were reported by the majority of identified studies.
Conclusions:
This review demonstrates the potential for multifactorial interventions aimed at individuals selected by CVD risk scores for lowering CVD risk and mortality. However, the majority of studies in this area do not provide an intensity of intervention which is sufficient in significantly reducing CVD mortality or validated CVD risk.
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