CHD Risk Assessment Tools

The Strengths And Limitations of CHD Risk Assessment Tools (JBS2 and SCORE)



The Strengths And Limitations of CHD Risk Assessment Tools (JBS2 and SCORE)

Many risk assessments are based on relatively simplistic strategies that have a clinician identify whether a “ risk factor” is present. However, national guidelines advocate the use of scoring systems for coronary heart disease (CHD) risk. Sophisticated methods like the Framingham Risk Score (FRS), European Systematic Coronary Risk Evaluation (SCORE), and Sheffield risk and treatment table allow calculation of a person's risk as a function of their values for selected established CHD risk factors. Use of these scoring systems is limited by the need for laboratory measurements. They could potentially be improved with the addition of such variables as family history of premature CHD, physical activity, and anthropometric measures of obesity. Several advantages of a scoring system based on personal self-report include ease of data collection. Few studies have focused on creating CHD risk scoring systems based on patient self-reports.14 and 15 T.D. Miller, V.L. Roger, D.O. Hodge and R.J. Gibbons, A simple clinical score accurately predicts outcome in a community-based population undergoing stress testing, Am J Med 118 (2005), pp. 866-872. Thus, the purpose of this study is to develop a simple, patient self-report-based CHD risk score for the general population without previously diagnosed CHD and compare the utility of this new measure with the FRS in a large multiyear cohort.

Compare the use of the JBS2 risk assessment tool with SCORE

The Framingham risk score also underestimates risk in patients with diabetes (because of the small number of patients with diabetes in the original study and the limited therapy they received at that date). More specific calculators, such as the one derived from the UK Prospective Diabetes Study, are more appropriate for patients with diabetes.

The Joint British Guidelines (JBS2) argue that the CVD risk is so high in diabetes that all patients should be treated anyway. Other guidelines disagree. The solution may be to include blood glucose or glycated haemoglobin in risk calculators, which would take account of the excess risk from insulin resistance and the metabolic syndrome.

Other problems arise from seemingly trivial adjustments to the risk calculation pathway. Introducing adjustments for hypertension, obesity and ethnicity can all result in exaggeration of predicted risk. Sometimes these adjustments seem to have a spurious precision. Risk calculations that differentiate between Bengalis and Gujaratis are more likely to reflect differences in the small population samples used to derive the data, rather than an innate difference in genetic predisposition to risk.

Healthy Heart Scores could range between 5 and 18, with lower scores suggesting a healthier cardiovascular profile. Seventy-seven children volunteered for blood samples in order to assess the relationship between the Healthy Heart Score and (total cholesterol (TC), high and lowdensity lipoprotein cholesterol (HDL, LDL) and triglycerides (TG). Fifty eight percent of children had elevated scores for at least 1 risk factor. The group mean Healthy Heart Score was 8 ...