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Statin treatment for Hypercholesterolaemia should be
considered if CHD Risk >15-30% |
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Drug treatment for Hypertension should be considered
if [BP >=160/100], OR if [BP >=140/90 AND {CHD Risk >15%
OR (target organ damage (eg LVH) or diabetes or CV complications)}] |
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People with an absolute risk of >=15% should be
considered for treatment with Aspirin, unless C/I |
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Risk may be about 30% higher in Asians, and may be
lower in Southern Mediterranean people |
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Risk of CHD event in Familial Hypercholesterolaemia
by ages 50, 60 and 70 in Men is 51%, 85% and 100%, in Women 12%, 57%, 74% |
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"Ideal" CHD risk is obtained with: Total
Cholesterol <4.1, HDL=1.2 (Male), 1.4 (Female), SBP<120, Non smoker, no
Diabetes and no ECG LVH |
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Risk of thromboembolic stroke in AF is reduced more
by Warfarin than Aspirin if Previous TIA/CVA, or >65yrs with additional
risk factor(s) (risk then usually >6%, reduced to <5% on Warfarin) |
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References: |
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Anderson KM, Wilson PWF, Odell PM, Kannell WB. An updated Coronary Risk Profile. Circulation 1991;83:356-62 |
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Wolf PA, D'Agostino RB, Belanger AJ, Kannel WB Probability of stroke: a risk profile
from the Framingham Study. Stroke
1991;22:312-8 |
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Joint British recommendations on prevention of
coronary heart disease in clinical practice.
Heart 1998;80 (supplement 2):S1-S29 |
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Wood DA, et al
Prevention of coronary heart disease in clinical practice. Recommendations of the second joint task
force of the European Society of Cardiology, European Atherosclerosis Society
and European Society of Hypertension.
Eur Heart J 1998;19:1434-503 |
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Designed by Dr John Bayliss (1999-2002) v11 |
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West Hertfordshire Cardiology, Hemel Hempstead
Hospital, Herts HP2 4AD |
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Framingham Risk Calculations: "Ideal" risk |
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Expected 10 year probability of CHD Event |
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Age |
Avg M |
Ideal M |
Avg F |
Ideal F |
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30 |
0.03 |
0.02 |
0.005 |
0.005 |
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35 |
0.05 |
0.03 |
0.005 |
0.005 |
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40 |
0.07 |
0.03 |
0.02 |
0.01 |
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45 |
0.11 |
0.04 |
0.05 |
0.02 |
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50 |
0.14 |
0.05 |
0.08 |
0.03 |
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55 |
0.16 |
0.06 |
0.12 |
0.04 |
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60 |
0.21 |
0.08 |
0.12 |
0.04 |
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65 |
0.28 |
0.1 |
0.1 |
0.04 |
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70 |
0.23 |
0.13 |
0.11 |
0.03 |
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74 |
0.23 |
0.13 |
0.11 |
0.03 |
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Expected 10 year probability of Stroke |
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Age |
Avg M |
Avg F |
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55 |
0.059 |
0.03 |
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60 |
0.078 |
0.047 |
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65 |
0.11 |
0.072 |
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70 |
0.137 |
0.109 |
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75 |
0.18 |
0.155 |
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80 |
0.223 |
0.239 |
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Guidance "rules" |
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TC (FH) |
If Total Cholesterol >7.5, consider FH |
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HDL |
If HDL <0.9, risk of atheroma is increased |
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BP |
If SBP 140-159,consider drug Rx if CHD risk >15%
or DM, CV complications or Target Organ Damage(eg LVH), but if SBP >=160
consider drug Rx for Hypertension: Target<140/90 |
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AF |
If AF AND ((Annual stroke risk =>6% so 10yr risk
=>60%) OR (presence of another risk factor {age >75, Hypertension,Hypercholesterolaemia,
Smoker, Diabetic or known CHD,CHF or PVD}) |
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consider Warfarin, if just lone AF consider Aspirin |
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CHD risk calculation not valid if patient has FH
(suggested by TC >7.5) or known CHD |
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