Statin treatment for Hypercholesterolaemia should be considered if CHD Risk >15-30%

 

 

 

 

 

 

 

 

 

 

Drug treatment for Hypertension should be considered if [BP >=160/100], OR if [BP >=140/90 AND {CHD Risk >15% OR (target organ damage (eg LVH) or diabetes or CV complications)}]

 

 

 

People with an absolute risk of >=15% should be considered for treatment with Aspirin, unless C/I

 

 

 

 

 

 

 

 

 

Risk may be about 30% higher in Asians, and may be lower in Southern Mediterranean people

 

 

 

 

 

 

 

 

 

Risk of CHD event in Familial Hypercholesterolaemia by ages 50, 60 and 70 in Men is 51%, 85% and 100%, in Women 12%, 57%, 74%

 

 

 

 

 

 

"Ideal" CHD risk is obtained with: Total Cholesterol <4.1, HDL=1.2 (Male), 1.4 (Female), SBP<120, Non smoker, no Diabetes and no ECG LVH

 

 

 

 

 

 

Risk of thromboembolic stroke in AF is reduced more by Warfarin than Aspirin if Previous TIA/CVA, or >65yrs with additional risk factor(s) (risk then usually >6%, reduced to <5% on Warfarin)

 

 

References:

 

 

 

 

 

 

 

 

 

 

 

Anderson KM, Wilson PWF, Odell PM, Kannell WB.  An updated Coronary Risk Profile.  Circulation 1991;83:356-62

 

 

 

 

 

 

 

 

Wolf PA, D'Agostino RB, Belanger AJ, Kannel WB   Probability of stroke: a risk profile from the Framingham Study.  Stroke 1991;22:312-8

 

 

 

 

 

 

Joint British recommendations on prevention of coronary heart disease in clinical practice.  Heart 1998;80 (supplement 2):S1-S29

 

 

 

 

 

 

 

Wood DA, et al   Prevention of coronary heart disease in clinical practice.  Recommendations of the second joint task force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension.  Eur Heart J 1998;19:1434-503

Designed by Dr John Bayliss (1999-2002)  v11

 

 

 

 

 

 

 

 

West Hertfordshire Cardiology, Hemel Hempstead Hospital, Herts  HP2 4AD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Framingham Risk Calculations: "Ideal" risk

 

 

Expected 10 year probability of CHD Event

 

 

 

 

 

 

 

Age

Avg M

Ideal M

Avg F

Ideal F

 

 

 

 

 

 

 

30

0.03

0.02

0.005

0.005

 

 

 

 

 

 

 

35

0.05

0.03

0.005

0.005

 

 

 

 

 

 

 

40

0.07

0.03

0.02

0.01

 

 

 

 

 

 

 

45

0.11

0.04

0.05

0.02

 

 

 

 

 

 

 

50

0.14

0.05

0.08

0.03

 

 

 

 

 

 

 

55

0.16

0.06

0.12

0.04

 

 

 

 

 

 

 

60

0.21

0.08

0.12

0.04

 

 

 

 

 

 

 

65

0.28

0.1

0.1

0.04

 

 

 

 

 

 

 

70

0.23

0.13

0.11

0.03

 

 

 

 

 

 

 

74

0.23

0.13

0.11

0.03

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expected 10 year probability of Stroke

 

 

 

 

 

 

 

 

Age

Avg M

Avg F

 

 

 

 

 

 

 

 

 

55

0.059

0.03

 

 

 

 

 

 

 

 

 

60

0.078

0.047

 

 

 

 

 

 

 

 

 

65

0.11

0.072

 

 

 

 

 

 

 

 

 

70

0.137

0.109

 

 

 

 

 

 

 

 

 

75

0.18

0.155

 

 

 

 

 

 

 

 

 

80

0.223

0.239

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Guidance "rules"

 

 

 

 

 

 

 

 

 

 

 

TC (FH)

If Total Cholesterol >7.5, consider FH

 

 

 

 

 

 

 

 

 

 

HDL

If HDL <0.9, risk of atheroma is increased

 

 

 

 

 

 

 

 

 

 

BP

If SBP 140-159,consider drug Rx if CHD risk >15% or DM, CV complications or Target Organ Damage(eg LVH), but if SBP >=160 consider drug Rx for Hypertension: Target<140/90

 

AF

If AF AND ((Annual stroke risk =>6% so 10yr risk =>60%) OR (presence of another risk factor {age >75, Hypertension,Hypercholesterolaemia, Smoker, Diabetic or known CHD,CHF or PVD})

 

consider Warfarin, if just lone AF consider Aspirin

 

 

 

 

 

 

 

 

 

 

CHD risk calculation not valid if patient has FH (suggested by TC >7.5) or known CHD