Abstract 1006: Impact of a Change to Global Cardiovascular Risk Estimation in Lipid-Lowering Guidelines: Findings From the National Health and Nutrition Examination Survey (NHANES) 2001 to 2006
Background: Current ATP-III guidelines use absolute risk for hard coronary heart disease (CHD) to determine need for lipid-lowering therapy. It is unknown how many more US adults would potentially be eligible for therapy (i.e., 10-year risk ≥10%) with a broader focus on risk for global cardiovascular disease (CVD; all CHD, stroke, TIA, claudication and heart failure).
Methods: We included 6,685 nonpregnant, nondiabetic, CVD-free participants aged 30 to 74 years from NHANES 2001–2006, representing 168 million US adults. We estimated 10-year predicted risk for hard CHD (using the Framingham risk score [FRS]) and global CVD (using the updated Framingham risk profile [UFRP]) in each participant. We compared the numbers of US adults in each of four predicted risk categories (0-<6%, 6-<10%, 10 –20%, and >20%) by FRS vs. UFRP for ages 30 – 49 and 50 –74 years.
Results: For those aged 50 –74 years (see Table⇓), 27% have 10-year predicted risk for hard CHD ≥10% by FRS, whereas 47% have 10-year predicted risk for global CVD ≥10% using UFRP. In other words, 16 million men and women are changed from <10% to ≥10% simply by using the expanded UFRP global CVD endpoint. For men, the proportion with ≥10% risk is 60% by FRS and 78% by UFRP, representing a shift of 5.5 million men; in women, the proportion goes from 6% to 28%, representing 10.5 million women. For those aged 30 – 49 years, the proportion of individuals who have ≥10% risk goes from 4% to 9%, representing a shift of 4.2 million people, almost all of whom are men.
Conclusions: Use of an expanded endpoint of global CVD (rather than hard CHD) for risk estimation results in 20.2 million men and women moving from lower (<10%) to higher (≥10%) 10-year estimated risk strata. At younger ages, more men are affected, whereas after age 50 more women are changed to higher risk. These data have implications for risk communication, selection of treatment thresholds and expected cost-benefit analyses if global CVD risk estimation is adopted by future guidelines.