What is a cardiovascular risk and factors?

Cardiovascular risk factors can be understood by the associated factors responsible for increasing the occurrence of cardiovascular disease. The association of factors is purely proportional based that means a person having presence of factors does not mean that he/she will land up suffering a heart or vessel related disease. However it is seen that people suffering cardiac problems initially had no occurrence of any identified factors.

Why it is important to assess the risk? Determination of cardiovascular risk in healthy or unhealthy adult is very important. Few factors can be modified like physical inactivity, obesity and abnormal weight, irregular blood pressure and smoking habits. In the healthy older adult or the older adult with cardiovascular disease (CVD), determination of cardiovascular risk is important. Risk is high if three out of these five factors are seen in any adult. First, Waist size in men more than 40 inches and women 35 inches. Second, HDL Cholesterol level in men should not be less than 40 mg/dL and female less than 50 mg/dL. Third, blood pressure greater than equal to 130/ or greater than equal to 85 mmHg. Fourth, fasting blood glucose level should not be more than equal to 110-125 mg/dL. Final is the symptoms of depression factors. Assessment tools for cardiovascular problemsThere are few tools available for assessing risk of cardiovascular problems, below two tools have been discussed helps in risk assessment. 1. Framingham Global Risk Assessment tools
2. PROCAM risk-assessment score

Framingham Global Risk Factor Assessment: Cardiovascular disease risk factor can be assessed by using different examinations. This includes history of patient along with the physical examination like details of vital stats, diagnostic testing and most important by using risk assessment tool. The Framingham Global Risk Assessment tools are combination of effective measures which is applicable for different populations.

Framingham Global Risk Assessment Tools- this tool includes measurement of following factors; for all scales 1. Hard coronary heart related disease like myocardial infarction or coronary death 2. Coronary heart related disease: the categorical value should be between 2-year and 10-year risk 3. General condition of cardiovascular disease 4. Cardiac stroke or Death after artery fibrillation 5. Intermittent claudication 6. Occurrence of coronary heart disease on regular basis 7. Congestive heart failure 8. Artery fibrillation

Composite score for risk assessment Assessment is done based on the below factors and finally a composite score is allotted to an individual suffering from cardiovascular disease; Age, cholesterol level, blood pressure level, high density lipoprotein cholesterol, smoking habits and presence of diabetes mellitus in individuals can lead to CVD.

Point range or scale The allotted point range is total of 30 points given based on the factor and the risks. If the score is less than nine, the risk is less than 1 %. But if the score is more than or equal to 25,the risk is more than 30 %.

Adults of age more than or equal to 40 years are assessed by using their family history and the factors associated with CVD. They are the targeted population of people who has the highest risk of occurrence of cardiovascular disease. Strength and limitation: This tool is gender specific and it has various risk factors associated with occurrence of CVD. This tool is helpful in case of females as well. Only specific limitation is that the age group is not fixed. This tool is widely used and accepted in the field of medicine. Due to inclusive of all possible factors this study covers all the risk related to CVD.

2. PROCAM scoring risk tool One more tool is used for evaluating risk of cardiovascular disease in adults. The PROCAM scoring risk assessment tool is used in estimating the occurrence of the risk of myocardial infarction or death due to acute coronary disease within the next 10 years. For evaluation and evidence support the data is considered from heart study centre and used for risk assessment of cardiovascular disease. The PROCAM Risk Scores there are two scores used for calculating 10 year risk of developing heart related problem and can be analyzed by using PROCAM scores. The different scores of PROCAM are the PROCAM Quick Check and second is the PROCAM Health Check.

Both the new score techniques are explained below and the use of this score in identifying the risk of coronary disease. 2.1 PROCAM Quick Check The PROCAM Quick Check method helps in fast and initial level assessment of coronary risk but only those variables are included where laboratory testing is not necessary. This score is developed based on the possible 450 coronary risk normally observed in a cohort of 5,000 men of age 35-65 years and minimum 10 years of irregular follow up with the health professionals.

Factors used for analysis by using PROCAM Quick Check Method; This technique is best used for males and females aged between 20-75 years. This is easily performed at home also because the blood test is not required. Technique helps in sufficient identification of risk accurately and can be diagnosed enough to visit a physician.
4.

1. 2. 3.

The data is collected in form of static and interactive forms.

2.2.

PROCAM Health Check Method

This technique checking method includes a much detailed score output calculated based on different 462 coronary risk observed in 18,460 men and 49 risk factor observed in 8,518 women. The age group is 20-78 years and studied for an average of 11.7 years.

This test includes laboratory values like Low Density Lipoprotein cholesterol, High Density Lipoprotein, triglycerides and blood glucose values. This technology gives more accurate value which is helpful in identification of coronary risk in men and women of age 20-75 years.

This can be start at very basic level, at the level where lifestyle changes can be noticed. This is said that the score is calculated in the cases of all suspects and before giving any medication to any suspect.

It can be used by clinicians and gives best result. The instructions are easy to follow as they are in interactive form.

Comparison of Framingham and PROCAM Score

For the comparison study subjects of the age group 35 to 75 years were taken condition is they had not been suffering from cardiovascular disease, or claustrophobia, or condition like artial fibrillation and premature contractions. The subjects were not included incase they had a life expectancy expected to be less than two years. Or not interested in giving consent form. Women of childbearing age not ready to use birth control methods are also excluded from this study. Total number of subjects taken for this comparison study is 100 in number. By the help of Framingham Risk Scores (FRS), it was estimated that risk related to 10 year of associated factors incase of fatal and non fatal myocardial infarction showed that total 24 subjects are at low risk that means 5-9 %, whereas total of 35 subjects are at very low risk which is less than 5 %, total 21 subjects are found at intermediate risk that is 10-19 %, and 20 subjects are at the high risk that means greater than equal to 20 %. The same calculation is performed with 45 men and studied over the period of 10 years PROCAM score the risk of 10.8 %.

References:

1. Best practice information on care of older adults: www.ConsultGeriRN.org.

2. American Heart Association Statistics Committee & Stroke Statistics Subcommittee.

(2009). Heart disease and stroke statistics 2009 update.

3. Brindle, P., Beswick, A., Fahey, T. & Ebrahim, S. (2006). Accuracy and impact of risk

assessment in the primary prevention of cardiovascular disease: A systematic review. Heart, 92, 1752-1759.

4. http://www.nhlbi.nih.gov/health/prof/other/index.htm#tools.

5. Conroya R, Pyorala.K, Fitzgerald A.( 2003) . Estimation of ten-year risk of fatal

cardiovascular disease in Europe: the SCORE project. Eur Heart J;24:9871003.

6. Keelan P, Bielak L, Ashai K,(2001). Long-term prognostic value of coronary

calcifications detected by EBCT in patients undergoing coronary angiography. 104:4127

7. Grundy S. (1999). Primary prevention of coronary heart disease-Integrating risk

assessment with intervention. Circulation .100: 98894.Newman AB, Shemanski L, Manolio TA, (1999). Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study. Arterioscler Thromb Vasc Biol ,19:53845.

Iglesias del Sol A, Moons K, Hollander M,( 2001). Is carotid intimaMedia thickness useful in cardiovascular disease risk assessment? The Rotterdam Study. Stroke. 32:15328.

Raggi P, Cooil B, Callister T. (2001).Use of EBCT data to develop models for prediction of hard coronary events. Am Heart J141:37582.

Callister T, Raggi P. (2001). EBCT: a Bayesian approach to risk assessment. Am J Cardiol . 88:3941E.