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Can cardiovascular disease guidelines that advise treatment decisions based on absolute risk be improved?
1Department of Molecular Cardiology, St. Vincent's Institute of Medical Research, Fitzroy, VIC, Australia. dcampbell@svi.edu.au.
Insights
Lowering the 10-year cardiovascular disease (CVD) risk threshold to 3% for younger adults significantly increases prevention of cardiovascular events. This strategy effectively prevents premature mortality and compresses morbidity to an older age.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) remains a leading cause of death and morbidity.
- Effective CVD prevention is crucial for reducing premature mortality and morbidity.
- Current guidelines use a 7.5% 10-year risk threshold for preventive treatment.
Purpose of the Study:
- To evaluate the impact of a reduced 10-year CVD risk threshold for preventive treatment in younger adults.
- To determine if a lower threshold can increase cardiovascular event prevention.
- To assess the effect on the number needed to treat.
Main Methods:
- Analysis of cardiovascular disease (CVD) risk using the pooled cohort equation.
- Comparison of a 7.5% risk threshold versus a 3% risk threshold in younger adults.
- Evaluation of cardiovascular event prevention and number needed to treat.
Main Results:
- Reducing the 10-year CVD risk threshold to 3% in younger adults (women <66 years, men <56 years) substantially increases cardiovascular event prevention.
- This lower threshold achieves greater event prevention with a similar number needed to treat.
- Preventive benefits are realized in individuals with greater life expectancy.
Conclusions:
- A 3% 10-year CVD risk threshold is more effective for preventing premature mortality in younger adults.
- Lowering the threshold helps compress morbidity to an older age.
- This revised approach optimizes CVD preventive treatment for younger populations.
Background:
Cardiovascular disease (CVD) will remain the predominant cause of death and a major cause of morbidity for the foreseeable future. Consequently, CVD prevention offers the greatest potential for the prevention of premature mortality and the compression of morbidity.
Discussion:
The 2013 guidelines of the American College of Cardiology and the American Heart Association expand the eligibility for CVD preventive treatment based on the calculated 10-year CVD risk derived from the pooled cohort equation to all persons who have a 10-year risk of CVD of ≥7.5% as estimated by the pooled cohort equation. Previous analyses show that the use of a uniform 10-year risk threshold of 7.5% for all ages disadvantages younger individuals for whom preventive therapy has most to offer. Here I show that reducing the threshold to 3% in younger adults (women aged <66 years and men aged <56 years) will substantially increase the number of cardiovascular events prevented at a similar number needed to treat to prevent one event. Importantly, this increase in cardiovascular event prevention will occur in individuals with greater life expectancy.
Conclusion:
Reducing the threshold 10-year risk of CVD derived from the pooled cohort equation for CVD preventive treatment to 3% in younger adults (women aged <66 years and men aged <56 years) will more effectively prevent premature mortality and compress morbidity to an older age.
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