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- Cardiovascular risk scores
- general practice
- primary prevention
- public health
- risk stratification
Coronary heart disease and stroke contribute significantly to premature mortality and morbidity. Largely preventable, they demand prevention. Emphases range from responsibilities of governments to individuals, and the clinic nurses or doctors advising and treating them. The risk of cardiovascular disease varies. To be efficient and effective, medical interventions must focus on those at highest risk.
The strongest marker of risk is existing cardiovascular disease (diabetes often included) demanding secondary prevention, now routine medical therapy. Next comes age, the criterion the polypill's promoters proposed for medicating the population.1 Age, sex and existing disease are major determinants of cardiovascular risk, but work begun 60 years ago in Framingham, USA,2 gave us risk factors—individual characteristics identifying increased risk. Combined as multifactorial risk they predict more than individual factors (see table 1). Since the Framingham classics (age, sex, smoking, blood pressure and lipids) other risk factors and scores have been proposed. The accompanying paper published in this issue of Heart examines some scores used currently in the UK (see page 491).3 How to choose?
The first criterion is utility. If a score is user-friendly, motivates the clinic nurse or doctor and the patient to start and persist with preventive action, it is a good score. A sheathed sword cannot cut. Any score that gives positive weighting to age, smoking, blood pressure and lipids will largely agree with another. Debate should not encourage nihilism. Easy implementation matters: factors included should be available, or justify their addition.
Chauvinism is a questionable criterion, but motivates new scores. From the USA came Framingham and preventive (not …tative) cardiology.4 Framingham is often depreciated as based on outdated, middle-aged Americans. In 1991 specifications for developing …
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