DALLAS, May 12 -- Predicting the future is never easy, but doctors may soon have the tools to help them do just that.
In a study and editorial in today's Circulation: Journal of the American Heart Association, researchers describe a score sheet that can help predict when a person may develop a fatal heart attack. The score card determines a patient's risk of heart disease based on risk factors such as blood pressure, blood cholesterol level and age, and whether or not a person smokes or has diabetes. The test gives one number for an individual's heart disease risk.
Peter W. F. Wilson, director of laboratories for the Framingham Heart Study and lead author of the study, says a doctor could have a one-page score sheet or put the scoring system on a computer in the office so a patient can see his or her risk as soon as the results of blood pressure and cholesterol tests are available. The patient and doctor could immediately work out a strategy for controlling any risk factors.
Philip Greenland, M.D., of the department of preventive medicine at Northwestern University Medical School and co-chairperson of the American Heart Association's Preventive Cardiology Committee, whose accompanying editorial about risk assessment is published in the association's journal, says the tool can be a powerful motivator to patients because they show how lifestyle changes such as improving diet or quitting smoking can lower their risk.
The number can be used to show how one person's risk compares to people of the same age whose risk factor scores are average or below. The Framingham report is one of the first to calculate an absolute risk of developing heart disease in the next 10 years.
"The global view of risk factors is significant. Although individual risk factors are important, they are also important collectively," Greenland says. "The more risk factors somebody has, even mildly so, the greater the individual's risk of developing heart disease."
Greenland says for a risk reduction tool to be effective, physicians must collect information through medical testing, correctly interpret the person's risk and take the appropriate steps to help reduce that risk. Problems occur at each step of the process, from physicians who fail to perform the routine tests necessary for a good assessment to failure of individuals to achieve target goals for blood pressure, blood cholesterol levels and other risk factors. In addition, people with more than one risk factor pose particular challenges. Because absolute risk varies between populations and regions, using relative risk is the more useful comparison at the moment, says Rodman Starke, M.D., the American Heart Association's executive vice president of science and medicine. "Absolute risk is an active area of research right now because determining absolute risk will allow doctors to identify more accurately those people who need aggressive interventions to reduce their risk factors and risk of heart disease," he says.
"The Framingham Heart Study is one of the world's best set of data," he adds. "However, the suburb west of Boston where the study is based is mostly white and middle class without much socio-economic or ethnic diversity. If you go from Framingham to Birmingham, you are going to have a different absolute risk." To solve these problems, the American Heart Association, the National Heart, Lung, and Blood Institute, and the American College of Cardiology will review cardiovascular risk assessment tools and advise doctors on how to improve risk assessment and treatment of heart disease, Starke says. "To accomplish our goal of getting something into the hands of doctors, the AHA is preparing a relative risk assessment on the new Framingham data, which will be available soon." Funded by the NHLBI and conducted by the institute and Boston University researchers, the Framingham study includes information from two generations in one Massachusetts community since 1948. According to the NHLBI director Claude Lenfant, M.D., "The risk assessment tool -- like so many of Framingham's research accomplishments in the past 50 years -- advances our understanding of cardiovascular disease. But now we have to determine how physicians and patients can best use this information about the effect of risk factors together. The NHLBI will be convening experts in the field to work out more precisely how this approach applies to various population groups and how it can be used in practice to help focus attention on effective treatment of an individual's specific risk factors."
Wilson's co-researchers include: Ralph B. D'Agostino, Ph.D.; Daniel Levy, M.D.; Albert M. Belanger, B.S.; Halit Silbershatz, Ph.D.; and William B. Kannel, M.D. Greenland's co-authors include Scott Grundy, M.D., Ph.D.; Richard C. Pasternak, M.D.; and Claude Lenfant, M.D.