25 June 2019

Predicting how long you can live in good health

  There are plenty of online cardiovascular risk calculators.  But which one is best for you?  That’s the focus of a paper published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1

“Risk calculators estimate the chance of an individual having a heart attack or stroke and pinpoint the lifestyle changes and medications that would be most effective to reduce that risk,” said author Dr Xavier Rossello, of the Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.

U-Prevent is free for the public and health professionals and is recommended as the only tool with calculators for different categories of people:  patients with cardiovascular disease (CVD), patients with type 2 diabetes mellitus, people under 70 with neither of those conditions, and people aged 70 or older (with or without CVD or diabetes). It can be used to calculate 5- and 10-year risk of CVD and the lifetime treatment effect of specific drugs on CVD-free life expectancy.

“Patients should be aware of the likelihood that they will develop CVD and these tools are a way to find out,” said Dr Rossello. “The second step is to take actions to minimise the probability as much as possible. This should be individualised based on risk factors, personality, and family and work environment. Adherence is best when decisions are shared between the clinician and patient.”

Prevention of CVD is a lifelong endeavour and motivation to continue taking pills and have a healthy lifestyle may be low if there are no symptoms. Seeing the projected benefit of taking preventive medication may be a good incentive. Choices can also be made about lifestyle changes that would reduce the likelihood of CVD even further.

The paper lists the freely accessible online tools for estimating cardiovascular prognosis. For each, it details which patient group and geographical region it can be used for, and the outcomes it predicts.

“European guidelines on cardiovascular prevention recommend the use of prediction tools2 but they are underused,” said Dr Rossello. The paper argues that as the population ages and the prevalence of obesity and diabetes increases, there is an urgent need for repeat risk assessment and personalised CVD prevention.

“Risk prediction tools assess prognosis in an objective and unbiased way,” said Dr Rossello. “This should avoid both over- and under-treatment and lead to the best outcomes and use of resources. Traditional methods rely on clinical judgement, experience, and personal beliefs and are therefore inconsistent and may be inaccurate.”

He added: “Current risk scores were developed using conventional statistical techniques to predict death. New techniques, such as machine learning, will be used to increase the accuracy of some current tools and to develop risk algorithms that predict subclinical disease. This information would allow clinicians and patients to take healthy preventive actions at an earlier stage.”

The paper is a result of the ESC Prevention of Cardiovascular Disease Programme run by the European Association of Preventive Cardiology (EAPC) in collaboration with the Association of Cardiovascular Nursing and Allied Professions (ACNAP) and the Acute Cardiovascular Care Association (ACCA). It is also published in European Heart Journal – Acute Cardiovascular Care and the European Journal of Cardiovascular Nursing.

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