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Cardiovascular 10-year score may underestimate disease risk, study warns



The scores used to estimate the cardiovascular risk of younger patients over ten years could be an underestimate, a study has warned.

In the largest study of its kind, based on the records of almost 400,000 patients, researchers found the likelihood of developing cardiovascular disease increased with higher non-HDL cholesterol levels – particularly for those at a younger age.

Patients under the age of 45 saw their lifetime risk of cardiovascular disease cut the most as a result of reducing their cholesterol levels, according to the research, published in The Lancet.

However, the researchers concluded that further research was needed before recommending more statins were given to younger patients.

Researchers used data from the cohort to create a tool for modelling disease risk. They found that by halving non-HDL cholesterol levels, women and men younger than 45 years with starting levels of non-HDL cholesterol between 3.7-4.8 mmol/litre – and who had two additional cardiovascular risk factors – could reduce their risk of disease before the age of 75 from around 16% to 4%, and from around 29% to 6%, respectively.

The greatest risk reduction was seen in patients who started lipid-lowering treatment the earliest.

Those behind the study warned current risk scores used to assess risk over 10 years ‘may underestimate lifetime risk, particularly in young people’.

They noted the research ‘may provide helpful insights on the benefits of lipid-lowering therapy as primary prevention from an earlier age’.

The paper said: ‘Only a few studies have reported the age­-dependent association of lipids and cardiovascular disease with focus on young individuals. In our analyses, individuals younger than 45 years showed the strongest hazard ratios for the association of blood lipids with the incidence of cardiovascular disease during long-term follow-up.’

Professor Stefan Blankenberg, one of the authors and professor of medicine at the German Center for Cardiovascular Research, said: ‘The risk scores currently used in the clinic to decide whether a person should have lipid-lowering treatment only assess the risk of cardiovascular disease over 10 years, and so may underestimate lifetime risk, particularly in young people

‘In lieu of needed clinical trial results investigating the benefits of long-term lipid-lowering therapy in people younger than 45, this study may provide helpful insights on the benefits of lipid-lowering therapy as primary prevention from an earlier age. However, future research is needed to understand whether intervention in young people with a high lifetime risk, but low 10-year risk, would have more benefits than later intervention.’