Cardiovascular Risk Assessment at Regular Intervals

A few months ago, on January 31st, 2021 to be precise, I wrote a piece about measuring our own cardiovascular risk ourselves. I reiterate. This is a must. No one else is going to do this for you and all we need are blood pressure measurements and blood sugar and lipid levels, which we can get from any good laboratory at negligible cost.

As I had mentioned, there are no “Indian” calculators, but QRISK3 out of the UK and the AHA/ACC risk calculators come closest to being effective in the Indian population.

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SCORE, which is used in the European Union also works, but I am not sure how well it would do in our population.

What hasn’t been known so far is whether a follow-up risk evaluation at 5 years, using these calculators, taking into account any changes that may have occurred in the interim, helps with better risk stratification, indicating whether the risk has improved or worsened.

A recent study headed by Lindbohm JV [1] that followed 7574 people over 18.7 years showed that measuring risk using SCORE or AHA/ACC every 5 years made a difference to risk assessment and subsequent interventions. This is a big deal, because risk assessment is something we can do on our own. And why every 5 years? At an individual level, you can do this every year, or ask your doctor to do it with you as an annual exercise. The authors have also created a new risk calculator that takes into account  change over 5 years.

Assessing your own risk is the basis of how to proceed with cardiovascular disease management. If you are at high risk, then you need to see a physician to get a management plan. If you are not at risk, then you can continue with better lifestyle measures  (physical activity, sensible eating) to make sure that your low risk does not progress. Importantly, when you check your risk again after a few years or annually, you will get to know whether what you are doing is working or not and change strategy accordingly.

Footnotes

1. Lindbohm JV, Sipilä PN, Mars N, Knüppel A, Pentti J, Nyberg ST, Frank P, Ahmadi-Abhari S, Brunner EJ, Shipley MJ, Singh-Manoux A, Tabak AG, Batty GD, Kivimäki M. Association between change in cardiovascular risk scores and future cardiovascular disease: analyses of data from the Whitehall II longitudinal, prospective cohort study. Lancet Digit Health. 2021 Jul;3(7):e434-e444. doi: 10.1016/S2589-7500(21)00079-0. PMID: 34167764.