Authors' objectives:

The aims of this study were: 1. Report on the current state of CVR prevention in France in 2004 (primary prevention) 2. Define the limits of global CVR assessment methods 3. Discuss the anticipated benefits of using risk models in everyday practice.

Authors' results and conclusions: (i) Estimating global CVR. Global risk is estimated - either by adding CVR factors, each factor being considered as either present or absent and having an identical weighting; - or by statistical modelling, which uses the true value of each CVR factor. (ii) Sum of risk factors. Global CVR estimate lacks precision as it does not incorporate all the information and includes inter- and intra-observer variability. Few studies have assessed its performance in classifying patients and distinguishing those who will experience a cardiovascular event from those who will not. (iii) Risk models. Two risk models (Framingham and SCORE) have been validated. They classify patients by risk level and predict risk of a cardiovascular event in 5 or 10 years' time. Their performance has not been assessed in a French population representative of the general population. The Framingham models, derived from North American cohorts, overestimate global CVR and adjustment (or recalibration) is required. The SCORE models, derived from European cohorts, estimate only the risk of death from coronary or non-coronary cardiovascular disease, and use one of two formulae depending on low or high prevalence of cardiovascular disease. (iv) Limitations of risk models. The following need to be assessed: - the treatment intervention threshold in relation to anticipated benefit for the patient; - the long-term impact of using risk models as an aid to treatment decision-making.

Authors' recommendations: The literature review and discussion among experts suggested that risk models could be used as a communication tool to bring about changes in medical practice and patient behaviour. On updating, guidelines on CVR factors (hypertension, dyslipidaemia and diabetes) need to be standardised in terms of method used to estimate global CVR (recalibrated Framingham and/or SCORE) and management strategy for individuals with several CVR factors.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: L'Agence Nationale d'Accreditation d'Evaluation en Sante (ANAES)