By Adam Legge
Exclusive: GP care of cardiovascular illness is set to be turned upside down later this year, with estimates of a patient’s 10-year cardiovascular risk to be abandoned – in favour of calculating lifetime risk instead.
Pulse understands the dramatic move is favoured by cardiology specialists working on JBS3, the latest revision of Joint British Societies guidance on prevention of cardiovascular disease, which is due out in October.
A switch to lifetime risk would tell a patient the probability they will have a cardiovascular event over their lifetime, and give them an estimate of the number of years of life they could use due to a modifiable risk factor.
And unlike current risk assessment tools, it would also give meaningful estimates in younger patients – and is likely to lead to more of them receiving treatment.
Dr Mike Knapton, associate medical director at the British Heart Foundation and a GP in Cambridge, said calculating lifetime cardiovascular risk was considered in JBS2 but failed to make the final cut.
But he told Pulse the idea had grown in support since: ‘It’s more useful to explain to someone the number of years of life they may lose due to a lifestyle factor like smoking – rather than telling them your 10-year risk of CVD is 20%, for example.’
Dr Kathryn Griffith, a GP in York and chair-elect of the Primary Care Cardiovascular Society, said: I think that it will be better because all the existing scores depend highly on age. It will help manage the young person who is at low absolute risk, for example age 28, smoking 20 per day and with a cholesterol ratio 5 , but at high lifetime risk.’
This opportunity to assess risk in younger patients, giving them an earlier opportunity to modify unhealthy behaviour, is thought to be a key driver for the change.
At the moment the only way of assessing risk of someone in their 20s using Framingham is to move them up into the first age bracket – the under 50s – but that is likely to give them a low 10-year risk despite having a high lifetime risk.
Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire and a GP in Radlett said: ‘If you tell someone their absolute risk of developing cardiovascular disease you have to find a way to put it into context. It is much more meaningful.’
JBS set to swap 10-year CVD risk score for lifetime risk