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Coronary Risk Classification

Background

Intended Use

Reporting Units

Limitation of Procedure

Free Coronary Risk Profile

 

Background

A number of medical parameters (risk factors) have been found to be associated with a distinctly increased likelihood (risk) of developing coronary heart disease (CHD), as manifested by sudden coronaty death, myocardial infarction, or angina pectoris. Multiple epidemiological studies have shown that the incidence, or occurence, of coronary heart disease can be predicted for groups of people well in advance of the appearance of symptoms using objectively measured risk factors for CHD. The major risk factors for CHD ang its prediction are: sex, age, cigarette smoking , elevated blood pressure, high levels of serum cholesterol, low HDL cholesterol, diabetes, certain electrocardiographic (ECG) abnormalities sucha as left ventricular hypertrophy (LVH), and certain others including but not limited to, obesity, family history of coronary disease, sedentary life-style, and apolipoproteins such as Lp.

Recently, emphasis in medicine and cardiology has been on individual risk factors such as high blood cholesterol or high blood pressure. Schemata have been developed which target individuals with high levels of either of these two risk factors but each schema also emphasized the need to consider other risk factors in the estimation of coronary heart disease risk. For example the National Cholesterol Education Program recommends a classification of individuals based on cholesterol serum levels. People whose cholesterol levels are > or equal 240mg/dl are considered "high risk" for development of CHD. The guidelines also identify people with "borderline high" cholesterol  levels (200-239 mg/dl) who warrant more aggressive preventive treatment - if two or more other CHD risk factors are also present.

 

Intended Use

The CRC should ideally be used as one piece of the CHD risk assessment in a given patient. It should be combined with other information and parameters available from the clinical patient evaluation. The risk prediction provides the physician with a diagnostic tool but should not be considered a substitute for the physician's judgement.

When generalization seems reasonable, the CRC estimation of risk can be useful in projecting patient progress at clinics at which preventive cardiology is the goal, such as primary care medicine, or in specialized lipid or blood pressure programs. Risk factor scores and calculations can be discussed with patients and provide a framework for intervention. Clinician can predict possible rewards in the form of improved profiles for patient who make the appropriate although often difficult changes in smoking, eating, and exercise habits.

 

Reporting Units

The CRC risk estimates are reported according to the 5 year and 10-year probabilities per 100 of developing CHD. Thus, the estimate represents a percent risk of developing CHD over the specified time periods.

 

Limitations of the Procedure

The estimated risk of CHD determined by the updated Framingham risk equation should be taken only as a guide to risk. The estimates are accurate estimates of group experience but not necessarily the experience of any one individual. Also the estimates are based only on 8 risk factors (gender is included in the risk for people of same age and gender). In addition, the equation used in the Framingham risk estimates are limited to individuals between the ages of 30-74, without previous cardiovascular disease and in whom all measurements are available. Especially in individuals with known previous cardiovascular disease, the risk estimates wil not be valid.

The variables selected for use in the risk estimate are an efficient set of independent contributors to risk which are objective, can be used in an unprepared patient, and are commonly available in clinical practice. It is recognized that certain risk factors for CHD are not included in the CRC estimates. These include, among others, obesity, level and amount of exercise, heredity, and extremely elevated risk factors (e.g., malignant hypertension, or severe diabetes mellitus), or extremely high values of total-cholesterol or HDL-cholesterol that place them in the top or bottom few percentiles of the distributions.

 

Free Coronary Risk Profile, please send us the following data:

1. Age

2. HDL-C (mg/dl)

3. Total Cholesterol (mg/dl)

4. Systolic Blood Pressure

5. Smoker (yes or no)

6. Diabetes (yes or no)

7. ECG - Left Ventricular Hypertrophy (yes or no)

 

 

 

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