Women Up, Men Down: The Clinical Impact of Replacing the Framingham Risk Score with the Reynolds Risk Score in the United States Population

<div><h3>Background</h3><p>The Reynolds Risk Score (RRS) is one alternative to the Framingham Risk Score (FRS) for cardiovascular risk assessment. The Adult Treatment Panel III (ATP III) integrated the FRS a decade ago, but with the anticipated release of ATP IV, it remains uncertain how and which risk models will be integrated into the recommendations. We sought to define the effects in the United States population of a transition from the FRS to the RRS for cardiovascular risk assessment.</p> <h3>Methods</h3><p>Using the National Health and Nutrition Examination Surveys, we assessed FRS and RRS in 2,502 subjects representing approximately 53.6 Million (M) men (ages 50–79) and women (ages 45–79), without cardiovascular disease or diabetes. We calculated the proportion reclassified by RRS and the subset whose LDL-C goal achievement changed.</p> <h3>Results</h3><p>Compared to FRS, the RRS assigns a higher risk category to 13.9% of women and 9.1% of men while assigning a lower risk to 35.7% of men and 2% of women. Overall, 4.7% of women and 1.1% of men fail to meet newly intensified LDL-C goals using the RRS. Conversely, 10.5% of men and 0.6% of women now meet LDL-C goal using RRS when they had not by FRS.</p> <h3>Conclusion</h3><p>In the U.S. population the RRS assigns a new risk category for one in six women and four of nine men. In general, women increase while men decrease risk. In conclusion, adopting the RRS for the 53.6 million eligible U.S. adults would result in intensification of clinical management in 1.6 M additional women and 2.10 M fewer men.</p> </div

Reynolds Risk Score Applied to Population of U.S. Women.

*<p>N/A: Risk category reclassification not possible in that direction.</p><p>(95% confidence intervals).</p>†<p>Percentage is based on proportion of risk category experiencing risk category reassignment.</p

Subject Characteristics.

<p>Subject Characteristics.</p

Trends in Low-Density Lipoprotein Cholesterol Goal Achievement in High Risk United States Adults: Longitudinal Findings from the 1999–2008 National Health and Nutrition Examination Surveys

<div><p>Background</p><p>Previous studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among U.S. individuals at high cardiovascular disease risk; however, recent studies in selected populations indicate improvements.</p> <p>Objective</p><p>We sought to define the longitudinal trends in achieving LDL-C goals among high-risk United States adults from 1999–2008.</p> <p><i>Methods</i> We analyzed five sequential population-based cross-sectional National Health and Nutrition Examination Surveys 1999–2008, which included 18,656 participants aged 20–79 years. We calculated rates of LDL-C goal achievement and treatment in the high-risk population.</p> <p>Results</p><p>The prevalence of high-risk individuals increased from 13% to 15.5% (p = 0.046). Achievement of LDL-C <100 mg/dL increased from 24% to 50.4% (p<0.0001) in the high-risk population with similar findings in subgroups with (27% to 64.8% p<0.0001) and without (21.8% to 43.7%, p<0.0001) coronary heart disease (CHD). Achievement of LDL-C <70 mg/dL improved from 2.4% to 17% (p<0.0001) in high-risk individuals and subgroups with (3.4% to 21.4%, p<0.0001) and without (1.7% to 14.9%, p<0.0001) CHD. The proportion with LDL-C ≥130 mg/dL and not on lipid medications decreased from 29.4% to 18% (p = 0.0002), with similar findings among CHD (25% to 11.9% p = 0.0013) and non-CHD (35.8% to 20.8% p<0.0001) subgroups.</p> <p>Conclusion</p><p>The proportions of the U.S. high-risk population achieving LDL-C <100 mg/dL and <70 mg/dL increased over the last decade. With 65% of the CHD subpopulation achieving an LDL-C <100 mg/dL in the most recent survey, U.S. LDL-C goal achievement exceeds previous reports and approximates rates achieved in highly selected patient cohorts.</p> </div

Prevalence of High Risk Conditions in Analyzed Populations NHANES 1999–2008.

<p>(95% CI).</p>*<p>p-value for test for trend over time.</p><p>CHD = coronary heart disease, FRS = Framingham Risk Score.</p

Inclusions/Exclusions.

*<p>Variable only collected in 1999–2000.</p>†<p>MEC Mobile Exam Center.</p>#<p>Peripheral Vascular Disease only collected in 99–00, 01–02, 03–04.</p

Population LDL-C Means and Goal Achievement.

*<p>To convert mg/dL to mmol/L multiply value by 0.0259.</p>†<p>p value compared to the previous survey.</p>‡<p>p value for test for trend over time.</p