The most important change in the new guidance is the emphasis on use of lifetime risk of cardiovascular events, in addition to 10-year likelihood, to help inform prevention strategies.
Individuals with a relatively low 10-year risk, but a high lifetime risk, such as younger people and women, should now be considered candidates for risk-modifying treatment.
The change reflects the fact that most CVD events occur in individuals who are at 'intermediate' risk, and that early treatment to prevent long-term exposure to CVD risk factors can modify disease progression and risk of future CVD events. In addition, cardioprotective drugs are now known to be safe and efficacious over the longer term, and have become cheaper.
To determine the lifetime risk of cardiovascular disease, JBS3 includes a new online risk calculator to assess the person's 'heart age' compared with a person of the same age, gender and ethnicity with optimal risk factors. The calculator also generates estimates of 10-year CVD risk and average CVD event-free survival.
The calculator allows GPs to model the effects of lifestyle modifications and other interventions on a patient's years of healthier life, using risk factors that are commonly and relatively easily measured. The results are intended to facilitate an informed discussion between the patient and clinician, and to motivate the patient to make changes to prevent future CVD events.
As with 10-year risk levels, lifetime risk estimates represent the average figures taken from studying large groups of people, so caution should be used when applying them to individual patients. The calculator should not be used for risk estimation in patients with known CVD, but may still be of use in this group to underscore their high risk and to emphasize the benefit of intervention.
Diet and lifestyle interventions and pharmacological therapy are equally important for intensive risk factor modification, both in patients with existing CVD, and in patients at high short-term, or high lifetime risk of developing CVD.
New lipid target
In addition to the new emphasis on lifetime CVD risk, lipid-lowering targets for total and LDL-cholesterol have been replaced by a single target for non-fasting non-HDL cholesterol of 2.5mmol/L.
The updated MIMS summary is available online and in every quarterly print edition of MIMS.
The MIMS summary of the NICE guideline on lipid modification for the prevention of cardiovascular disease was recently updated to reflect the latest version of the guidance, including lowering of the threshold for statin therapy to a 10-year CVD risk of 10%.