Cardiovascular risk prediction in the Netherlands

Background: In clinical practice, Systematic COronary Risk Evaluation (SCORE) risk prediction functions and charts are used to identify persons at high risk for cardiovascular diseases (CVD), who are considered eligible for drug treatment of elevated blood pressure and serum cholesterol. These functions use classical risk factors (age, gender, smoking, blood pressure and the ratio of total-to-HDL-cholesterol) to predict absolute 10-year risk of CVD mortality rather than total (fatal plus nonfatal) CVD. The aim of this thesis was to improve cardiovascular risk prediction in the Netherlands and to correctly classify high-risk persons. Methods: We primarily used data from the Monitoring Project on Chronic Disease Risk Factors (MORGEN project) of the National Institute for Public Health and the Environment (RIVM). Risk factor data of more than 20,000 men and women aged 20-65 years were collected between 1993 and 1997. Ten-year follow up data on CVD mortality and morbidity were obtained from Statistics Netherlands and the National Hospital Discharge Register, respectively. Risk functions were developed using multivariable Cox proportional hazard models. Results: The SCORE risk function for low-risk countries was the best predictor of CVD mortality in the Netherlands. Total CVD was approximately four times higher than CVD mortality. Obesity (BMI ≥30 kg/m2) and parental history of myocardial infarction before age 70 were independent predictors of total CVD. Risk functions predicting risk of CVD mortality and total CVD, and their ability to discriminate between future cases and non-cases, did not differ. Of the high-risk persons with a CVD mortality risk of at least 5%, approximately 20% developed a nonfatal or fatal CVD event during 10 years of follow-up. When a cut-off point of 2% CVD mortality was used, approximately 10% of the high-risk persons developed a CVD event. When obesity and parental history of MI were added to the classical risk factor function, correct risk classification improved by 5%. This improvement in risk prediction was mainly due to obesity. Conclusions: Discrimination between future cases and non-cases did not improve by expanding the endpoint of risk prediction from fatal CVD to total CVD. Adding obesity and parental history to the classical risk factor functions slightly increased the number of correctly classified persons. </p

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De Gezondheidsraad adviseerde in 2006 om niet meer dan 6 gram zout per dag binnen te krijgen. Maar zou vanuit gezondheidskundig perspectief de inname niet nog lager moeten zijn

Evaluation of cardiovascular risk predicted by different SCORE equations: The Netherlands as an example

Background: In Europe, for primary prevention of cardiovascular diseases (CVD), the Systematic COronary Risk Evaluation (SCORE) risk charts for high-risk and low-risk regions (SCORE-high and SCORE-low, respectively) are used. For the Dutch ‘Clinical Practice Guideline for Cardiovascular Risk Management’ an adapted SCORE risk chart (SCORE-NL) was developed in collaboration with the SCORE group. We evaluated these three SCORE equations using Dutch risk factor and mortality data. Design: Prospective cohort study with 10-year follow-up. Methods: Baseline data were collected between 1987 and 1997 in 32 885 persons aged 37.5–62.5 years. Vital status was checked and causes of death were obtained from Statistics Netherlands. On the basis of the level of risk factors, the expected number of CVD deaths was calculated by applying the three SCORE equations and compared with the observed number. Results: The observed CVD mortality was three-fold higher in men (n=242; 1.6%) than in women (n=83; 0.5%). On the basis of SCORE-NL, 8.5% of the men and 0.8% of the women had a CVD mortality risk of 5% or more. The ratio of the observed-to-expected number of CVD deaths was 0.75 for men and 0.55 for women using SCORE-NL, 0.54 and 0.56 using SCORE-high, and 1.11 and 0.95 using SCORE-low. Conclusion: At the population level, SCORE-low predicts the number of CVD deaths well, whereas both SCORE-NL and SCORE-high overestimate the number of CVD deaths by a factor 1.5–