Emma Malm

emma.snygg@hotmail.com

@ Cambio CDS

To calculate the 10-year risk for heart disease or stroke and provide statin recommendations.

Use to determine 10-year risk of heart disease or stroke and provide the intensity of statin therapy. The risk score (in %) for each race and gender is calculated by using the following formulas: White women: 10-year cardiovascular risk if risk factors were optimal**: 1.4% Estimated risk = 1 – 0.9665^(e^(Individual Sum - (-29.2))) Where Individual Sum = Ln(age)*(-29.799) + (Ln(age))^2*4.884 + Ln(total cholesterol)*13.540 + Ln(age)* Ln(total cholesterol)*(-3.114) + Ln(HDL cholesterol)*(-13.579) + Ln(age)* Ln(HDL cholesterol)*3.149 + Ln(treated systolic BP)*2.019 or Ln(untreated systolic BP)*1.957 + 7.574*smoker(No=0, Yes=1) + Ln(age)*smoker(No=0, Yes=1)*(-1.665) + 0.661*diabetes(No=0, Yes=1) African American women: 10-year cardiovascular risk if risk factors were optimal: 1.8% Estimated risk = 1 – 0.9533^(e^(Individual Sum – 86.61)) Where Individual Sum = Ln(age)*17.114 + Ln(total cholesterol)*0.940 + Ln(HDL cholesterol)*(-18.920) + Ln(age)* Ln(HDL cholesterol)*4.475 + Ln(treated systolic BP)*29.291 or Ln(untreated systolic BP)*27.820 + Ln(age)* Ln(treated systolic BP)*(-6.432) or Ln(age)*Ln(untreated systolic BP)*(-6.087) + 0.691*smoker(No=0, Yes=1) + 0.874*diabetes(No=0, Yes=1) White men: 10-year cardiovascular risk if risk factors were optimal: 3.6% Estimated risk = 1 – 0.9144^(e^(Individual Sum – 61.18)) Where Individual Sum = Ln(age)*12.344 + Ln(total cholesterol)* 11.853 + Ln(age)* Ln(total cholesterol)*(-2.664) + Ln(HDL cholesterol)*(-7.990) + Ln(age)* Ln(HDL cholesterol)*1.769 + Ln(treated systolic BP)*1.797 or Ln(untreated systolic BP)*1.764 + 7.837*smoker(No=0, Yes=1) + Ln(age)*smoker(No=0, Yes=1)*(-1.795) + 0.658*diabetes(No=0, Yes=1) African American men: 10-year cardiovascular risk if risk factors were optimal: 4.9% Estimated risk = 1 – 0.8954^(e^(Individual Sum – 19.54)) Where Individual Sum = Ln(age)*2.469 + Ln(total cholesterol)*0.302 + Ln(HDL cholesterol)*(-0.307) + Ln(treated systolic BP)*1.916 or Ln(untreated systolic BP)*1.809 + 0.549*smoker(No=0, Yes=1) + 0.645*diabetes(No=0, Yes=1) Statin recommendations: - High-intensity Statins: History of ASCVD present and age 40-75 yrs OR no history of ASCVD but LDL >= 190 mg/dl OR Estimated 10-year risk >= 7.5 % and Diabetes present. - Moderate to high-intensity Statins: Estimated 10-year risk > 7.5 % with no Diabetes - Moderate-intensity Statins: Estimated 10-year risk < 7.5 % with Diabetes OR Estimated 10-year risk between 5 - 7.5 %. - No Statin recommended: Estimated 10-year risk < 5 %.

Goff, D., Lloyd-Jones, D., Bennett, G., Coady, S., D’Agostino, R., Gibbons, R., Greenland, P., Lackland, D., Levy, D., O’Donnell, C., Robinson, J., Schwartz, J., Shero, S., Smith, S., Sorlie, P., Stone, N. and Wilson, P. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Washington: Journal of the American College of Cardiology, pp.49-73 [Internet]. 2013 Nov 12 [cited 2007 Jan 5]. Available from: https://www.ahajournals.org/doi/pdf/10.1161/01.cir.0000437741.48606.98. Stone, N., Robinson, J., Lichtenstein, A., Bairey Merz, N., Blum, C., Eckel, R., Goldberg, A., Gordon, D., Levy, D., Lloyd-Jones, D., McBride, P., Schwartz, J., Shero, S., Smith, S., Watson, K. and Wilson, P. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Washington: Journal of the American College of Cardiology, pp.1-45 [Internet]. 2013 Nov 12 [cited 2021 April 3]. Available from: https://www.ahajournals.org/doi/pdf/10.1161/01.cir.0000437738.63853.7a.

OBSERVATION.blood_pressure.v2, OBSERVATION.lab_test-lipids.v1, OBSERVATION.basic_demographic.v1, OBSERVATION.ascvd_statin_recommendation.v0, OBSERVATION.ascvd_risk_calculator.v0