There are three considerations about cardiac risk calculators. The first is that, whichever exact approach is taken, the idea is the same - to take measurements of cardiovascular health and analyze them for guidance on future potential heart problems and their prevention.
The second is that while the factors are common to whichever calculator is used, it is often one recommended by a doctor, validated for as much scientific accuracy as possible.
The third is that a prediction of future chances of heart problems is just that - a prediction. It is not supposed to be as scary or as certain as it might sound.
Risks can be put into perspective, and they would not be calculated unless there was something worthwhile that could be done to reduce them.
For some people, the predicted cardiac risk is so low that there would be no need to worry about further screening.
The reason why medicine has developed cardiovascular risk calculators is for the major effort to take on "the common risk factors fueling the epidemic of cardiovascular disease" - work that was pioneered by the game-changing Framingham Heart Study.1,2
Fast facts on cardiac risk calculators
Here are some key points about cardiovascular risk calculation. More detail is found in the article.
- Population statistics have worked out the most important risk factors for cardiovascular disease
- With this information, doctors have access to powerful predictors of individual heart attack risk based on factors that can lead to blocked arteries
- Reducing the risk of heart attacks and stroke for people as they get older can be helped by measuring individual biological factors, including those with direct or indirect links to lifestyle
- Age is one risk factor that cannot be modified but others such as cholesterol and blood pressure can
- The idea of these early predictions for a raised risk of a major heart event within 10 years is a guide for lifestyle changes that can bring the predicted risk down toward normal percentage chances
- People at a high risk of heart problems may require medical help such as statins or blood pressure drugs
- 10-year cardiac risk calculators are not designed for people who already have clinical cardiovascular disease - although there is still an element of risk predictability for these people, and doctors can still help with management and treatment.
What is a cardiac risk calculator?
Heart and brain can be affected by the balance of individual cardiovascular risks.
A cardiac risk calculator takes data for an individual's predictors of disease and uses population-level statistics to try and predict their chances of cardiovascular problems. These calculators return a percentage score to indicate heart risk.
Tools for working out how much more likely a heart attack might be over time are not for everyone. Such information is not useful for people who have been diagnosed with cardiovascular disease as their risks are already actively managed in a treatment direction rather than in this preventive direction.
This article will examine what factors are used by cardiac risk calculators and why, and what lifestyle measures and medical assistance can do to affect them.
Developments on cardiac risk calculation from MNT news
Medical professional societies and charitable organizations in the UK published heart disease prevention recommendations in the journal Heart in March 2014, when they also launched the JBS3 risk calculator.
The leading doctor behind this story used a presentation at the American Heart Association (AHA) meeting in November 2015 to call for all women over 40 to get their A-risk score, also known as the atherosclerotic cardiovascular disease (ASCVD) score.
What factors do cardiac risk calculators use?
All cardiac risk calculators use biological factors proven through large-scale studies to be related to the statistical chances of developing diseased arteries.
Some of these indicators are possible to be treated; these are known as modifiable risk factors. As a result, some of the causes of atherosclerosis and heart disease can be avoided or reduced.
Heart attack and stroke from clogged arteries are more likely with high cholesterol and high blood pressure among other factors.
Atherosclerosis is the narrowing of arteries due to the formation of plaques, which can happen in the arteries supplying the heart - the coronary arteries.
Heart disease prevention also helps against other problems as atherosclerosis can lead to stroke events when blood supply is cut off in part of the brain.
When cardiac risk is measured, three key factors cannot be adjusted: age, ethnicity and biological sex. Other factors are modifiable.
The best way to see all the elements used in a cardiac risk calculator is simply to have a look at one key example, jointly developed by the American College of Cardiology (ACC) and the American Heart Association (AHA).
Doctors may follow these 2013 risk assessment guidelines for anyone over 20 years of age and no older than 79 who is yet to show any outward signs of cardiovascular disease.3
The ACC/AHA risk score draws from a number of factors, and a calculator tool returns the result when clinical data from the following sources are put in:
- Patient characteristics and answers
- Doctor's office measurements
- Laboratory test results.
The predictor takes all the following variables recorded by those three sources to work out an individual risk score:
- Biological sex
- Total cholesterol and HDL cholesterol levels
- Blood pressure
- Treatment for high blood pressure (hypertension)
- Diabetes status
- Smoking status.
Statins against cholesterol
- A 10-year risk of 7.5% based on the risk factors of a heart attack calculator can be the starting point for long-term statin use to prevent cardiovascular disease and stroke
- The decision to prescribe statins is not always straightforward, however.
The score suggests the percentage chance of a heart attack or stroke within an individual's lifetime and within the next 10 years.
Conducting such a risk assessment requires accurate data from clinical testing and careful interpretation. Doctors will consider the individual meaning of doing a risk calculation and looking at the results.
How often the assessment is recommended depends on the age of the patient, with older groups being assessed up to as often as every 4 years.
The results give an indication of whether lifestyle adjustments or other preventive steps are needed to reduce cardiovascular risk.
Physicians should use slightly different risk calculations when needed - some ethnic and genetic characteristics are linked to a slightly higher risk when compared with the overall population, for example, while other people can have a lower risk according to nationwide statistics.
In the US, for example, if a cardiac risk calculator does not take account of these variables, it could slightly overestimate the risk in Puerto Rican people or underestimate it in Mexican Americans.
On the next page, we look at the best cardiac risk calculators, the results they show and how to act on them.