Abstract 3266: The Clinical Impact of the Reynolds Risk Score in United States Women
Background: The Reynolds Risk Score (RRS) reclassified 44% of Women’s Health Study subjects initially at intermediate risk by Framingham Risk Score (FRS). However, few women are at intermediate risk, and only a subset of reclassifications cause women to no longer meet LDL cholesterol (LDL-C) goal. We applied the FRS and RRS to US women age 45–79 to identify all whose risk category changed and those who would receive clinically meaningful changes in LDL-C treatment recommendations.
Methods: Using the National Health and Nutrition Examination Surveys 1999 –2002 we assessed all U.S. women ages 45–79, without atherosclerosis or diabetes, by FRS and RRS. LDL-C goals were assigned per guidelines to risk levels <6%, 6 – <10%, 10 – =20%. We calculated the percent reclassified by RRS and identified the subset that newly met or did not meet their LDL-C goals.
Results: Of the 43.4 million (M) U.S. women represented by the surveys, 87.8% were assigned the same risk by RRS and FRS. The RRS increased the risk category in 10.7% and decreased risk in 1.6% compared to FRS. In all, 3.7% of U.S. women did not meet their LDL-C goals by RRS when they had by FRS. Just 1.7% of this group (0.06% of all) were initially at intermediate risk by FRS.
Discussion: A major goal of risk assessment is to select cholesterol goals and intensify therapy for those above goal. Use of the RRS instead of the FRS intensifies therapy in only an additional 3.7% of all US women. As this population is small and the RRS requires that clinicians maintain additional calculators, it does not appear prudent to recommend routine RRS calculation. Using intermediate risk as a targeted subset population only finds 2% of those who might benefit by RRS use.