Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Trials

Background:

• Chest pain clinics manage patients presenting with chest pain, often identifying individuals at intermediate to high cardiovascular risk.
• Opportunistic cardiovascular risk factor modification can be integrated into routine clinic workflows.
• Assessing absolute cardiovascular risk guides targeted interventions for primary prevention.

Purpose of the Study:

• To evaluate the effectiveness of a proactive, absolute cardiovascular risk-guided strategy for modifying cardiovascular risk factors.
• To determine if this approach can reduce the 5-year absolute cardiovascular risk in patients without coronary ischemia attending a chest pain clinic.

Main Methods:

• A prospective, randomized, open-label, blinded endpoint study was conducted.
• Patients with intermediate to high 5-year absolute cardiovascular risk (≥8%) were recruited from a rapid access chest pain clinic.
• The primary endpoint was the change in the 5-year absolute risk score at a minimum 12-month follow-up.

Main Results:

• The intervention group showed a significant reduction in mean 5-year absolute risk score (-2.4 percentage points) compared to the control group (+0.4 percentage points).
• The between-group difference in risk score reduction was 2.7 percentage points.
• While the intervention group had larger improvements in lipid profiles, blood pressure, and smoking status, these did not reach statistical significance compared to the control group.

Conclusions:

• An absolute cardiovascular risk-guided, proactive risk factor management strategy effectively reduced 5-year absolute cardiovascular risk scores.
• This strategy can be successfully implemented opportunistically within chest pain clinic settings.
• The findings support the integration of risk-stratified primary prevention into specialized cardiac clinics.