Should we treat lifetime risk in CVD prevention? Should we treat lifetime risk in CVD prevention?

‘Coronary heart disease, despite a decrease in mortality over recent years, remains a major cause of morbidity and mortality across the world’, said Dr Peter Lansberg (Amsterdam, Netherlands). It is fifty years since the original work in the Framingham cohort which identified risk factors associated with cardiovascular disease (CVD). The INTERHEART study found that 90% of population attributable risk of myocardial infarction can be explained by nine risk factors. Targeting individuals at high risk alone is unlikely to reduce the overall prevalence of CVD. Population based approaches are also required if the CVD burden is to truly be addressed. Risk scores in use currently include Framingham (a white US population), SCORE (European) and Q Risk (from routinely collected GP data in the UK). Each scoring system has limitations, for example, Framingham is poor at predicting risk in women and non-white patients.

Dr Lansberg went on to discuss the concept of lifetime risk. Multiple risk factors at a young age can lead to subclinical atherosclerosis then CVD however most risk scores rely heavily on age as a key element to determine treatment threshold. ‘If we wait until the patient reaches the age at which the threshold for treatment stands, atherosclerosis will already be established’. The importance of aggressively treating lifestyle factors at all ages is paramount. A population approach is required to tackle risk factors such as high fat intake and obesity. Measures such as increasing tax on high calorie, high fat food may help to discourage poor eating habits. The shift in societal attitudes towards smoking could also be seen for unhealthy eating. Delegates were also given a challenge to ‘Practice what we preach’ by setting an example to our patients by eating healthily and taking regular physical exercise.
 

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