P-382: A second generation approach to cardiovascular risk assessment: The COSEHC cardiovascular risk assessment tool

• Published in: American journal of hypertension Vol. 18; no. S4; p. 144A
• Main Authors: Hawkins, Ralph G., Houston, Mark C., Ferrario, Carlos M., Moore, Michael A., Bestermann, William H.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2005
• Subjects: COSEHC; Global Risk Assessment; Primary Prevention
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2005.03.400

The Consortium for Southeastern Hypertension Control (COSEHC) is dedicated to reducing the mortality from cardiovascular (CV) disease in the Southeastern United States. With stricter clinical guidelines for the diagnosis and treatment of hypertension (HBP), hyperlipidemia (HL) and hyperglycemia (HG), a greater proportion of the public is at higher risk for CV events than was previously appreciated. There is concern that traditional risk assessment tools do not adequately assess the global risk that patients with HBP, HL and HG experience. The risk tool we present here was derived by amalgamating previous non-Framingham models, resulting in an evidence-based and easily applicable tool to identify CV mortality risk in clinical settings. The model identifies non-modifiable risk factors: [age, gender, height, serum creatinine, family history, previous MI and stroke history, diabetes status], modifiable risk factors: [LVH, systolic BP, smoking status, total cholesterol levels, HDL cholesterol, LDL cholesterol, triglyceride levels], and optional “non-traditional” risk factors: [homocysteine levels, fasting blood glucose in non-diabetics] to generate an objective risk score specific for individuals. The score estimates 5-year CV mortality risk, and individuals can be identified as high relative risk (above 60th percentile) compared to the reference population, or identified as high absolute risk (5-year mortality risk exceeding 2.5%). Profiling patients for risk status benefits them by identifying high risk individuals requiring more aggressive preventive treatment goals than would have been applied previously. This risk evaluation tool is widely generalizable, utilizes more variables than previous models, and is easily applied in a clinical setting. We conclude from this approach that a more comprehensive global risk assessment is possible. Final validation of this risk assessment tool will await the final results of prospective outcome studies which have begun in the Southeastern United States.