1. « Systematic Cerebrovascular and cOronary Risk Evaluation » Global Cerebrovascular Risk Assessment SCORE - Canada « Systematic Cerebrovascular and cOronary Risk Evaluation » This self-playing slide show lasts 2 minutes

2. « Systematic Cerebrovascular and cOronary Risk Evaluation » Multiple risk factors usually contribute to the atherosclerosis that causes cardiovascular disease. These risk factors interact, sometimes multiplicatively. Management of the individual components of risk such as smoking, diet, exercise, blood pressure and lipids impacts on total cardiovascular risk. Thus the aim should be to reduce total risk ; if a target cannot be reached with one risk factor, total risk can still be reduced by reducing other risk factors. SCORE « Systematic Cerebrovascular and cOronary Risk Evaluation »

4. 1.Assess the risk 2.Set the targets 3.Act to get to goal The SCORE CANADA message* * Canadian Vascular Coalition 2004 and C-CHANGE 2011 For every patient, clinicians should:

5. « Systematic Cerebrovascular and cOronary Risk Evaluation » Physical Exercise (Canadian Society of exercise physiology) Hypertension (Canadian Hypertension Education Program) Dyslipidemias (Canadian working group on hypercholesterolemia) Diabetes (Canadian Diabetes Society) The goals are those recommended by the major Canadian scientific organisations

6. « Systematic Cerebrovascular and cOronary Risk Evaluation » Use this risk evaluation chart if the patient asks for it and if during consultation the person is a middle age smoker or has one or more vascular risk factors or there is a family history of premature cardiovascular disease or of major risk factors. When should we use the SCORE Canada table? The charts should be used in the light of clinician’s knowledge and judgement with regard to local conditions.

7. « Systematic Cerebrovascular and cOronary Risk Evaluation » SCORECanada LOW ≤ 1% HIGH ≥ 5% 10 year Risk of fatal cardiovascular disease MODERATE 2-4%

8. « Systematic Cerebrovascular and cOronary Risk Evaluation » LOW ≤ 1% MODERATE 2-4% HIGH ≥ 5% SCORECanada 10 year Risk of fatal cardiovascular disease

9. « Systematic Cerebrovascular and cOronary Risk Evaluation » How to use the SCORE Canada table ? 1.Find the cell nearest to the person’s gender, age, total/HDL-chol. ratio and systolic blood pressure values, bearing in mind that the risk will be higher as the person approaches the next age, cholesterol or blood pressure category. 2.This will give you a percentage representing the risk of dying from vascular disease in next 10 years. 3.Risk may be higher than indicated in the chart if : preclinical atherosclerosis already established ; family history of premature cardiovascular disease: X by 1.7 /men and X by 2 in women obesity, BMI > 30 Kg/m 2, waist circumference 102 cm or higher in men or 88 cm or higher in women ; sedentarity ; diabetes: multiply by 3 in men and by 5 in women ; very high triglycerides ; high levels of hsC-reactive protein, fibrinogen, homocystein, apoliprotein B or Lp(a).

10. « Systematic Cerebrovascular and cOronary Risk Evaluation » LOW ≤ 1% MODERATE 2-4% HIGH ≥ 5% SCORECanada 10 year Risk of fatal cardiovascular disease

11. « Systematic Cerebrovascular and cOronary Risk Evaluation » - known cardiovascular disease, - Pts with diabetes :man> 45 years old,woman> 50 years old,presence for more than 25 years and aged >30,CV multi risks,microvascular disease - markedly increased single risk factors or - older than 70 years of age. When should we use the SCORE Canada table? The charts should be used in the light of clinician’s knowledge and judgement with regard to local conditions. Do not use SCORE if

12. « Systematic Cerebrovascular and cOronary Risk Evaluation » LOW ≤ 1% MODERATE 2-4% HIGH ≥ 5% SCORECanada 10 year Risk of fatal cardiovascular disease

13. « Systematic Cerebrovascular and cOronary Risk Evaluation » For younger people less than 40, Use the “Relative Risk” chart How to use the SCORE Canada table ? Use this chart to show younger people, less than 40, at low total risk that, relative to their age group, their risk may be many times higher than necessary. This may help to motivate and make decisions about avoidance of smoking, healthy nutrition and exercise, as well as flagging those who may become dandidates for pharmalogical treatment.

14. « Systematic Cerebrovascular and cOronary Risk Evaluation » Relative Risk chart for people of less than 40 years of age How to use the SCORE Canada table ? The number in each cell means that the person is “n” time more at risk of developing a vascular disease than someone who is at the same age and where all the other risk factors are minimal.

15. « Systematic Cerebrovascular and cOronary Risk Evaluation » 1. To Assist those at low risk of vascular disease to maintain this state lifelong, and to help those at higher increased total vascular risk to reduce it. 2. To Obtain the caracteristics of people who tend to stay healthy: 3. To achieve more rigorous risk factor control in high risk subjects, especially those with established vascular disease, diabetes or kidney disease. 4. To prescribe ASA, statin, ACE-I or ARB in these high risk subjects, especially those with established atherosclerotic disease. 5. To consider pharmacological treatment to control hypertension and/or diabetes. What the objectives of vascular prevention?

16. « Systematic Cerebrovascular and cOronary Risk Evaluation » 0 No smoking 5 Five portions of fruit and vegetable or more a day and healthy food choices 30 Thirty minutes of physical exercise (moderate intensity) a day 140 Blood pressure under 140/90 mmHg 5 Total-cholesterol under 5 mmol/L 3 LDL-cholesterol under 3 mmol/L 0 Zero diabetes ; fasting plasma glucose under 7 mmol/L 0 Zero obesity ; BMI under 25 Kg/m 2 and no abdominal obesity 2. To Obtain the caracteristics of people who tend to stay healthy What the objectives of vascular prevention?

17. « Systematic Cerebrovascular and cOronary Risk Evaluation » 3. To achieve more rigorous risk factor control in high risk subjects, especially those with established vascular disease, diabetes or kidney disease. What the objectives of vascular prevention?

18. « Systematic Cerebrovascular and cOronary Risk Evaluation » 4. To prescribe ASA, statin, ACEI or ARB in these high risk subjects, especially those with established atherosclerotic disease. 5. To consider pharmacological treatment to control hypertension and/or diabetes. What the objectives of vascular prevention? It is not recommended to use the SCORE tables to monitor risk level when medical treatment has been initiated

19. « Systematic Cerebrovascular and cOronary Risk Evaluation » 0 No smoking 5 portions of fruit and vegetable or more a day and varied healthy foods, cereals or whole wheat bread, fish, limit salt (sodium) intake 30 minutes of moderately vigourous exercice on most days Public Health Message

20. « Systematic Cerebrovascular and cOronary Risk Evaluation » Practical Recommendations Lifestyle advice to maintain low risk status Reassess global risk every 2 years Recommendations 0 No smoking 5 portions of fruit and vegetable or more a day and varied healthy foods, cereals or whole wheat bread, fish, limit salt (sodium) intake 30 minutes of moderately vigourous exercice on most days Reduce weight if BMI > 25 kg/m2 or waist circumference equal or higher than 88 cm (women), 102 cm (men) If SCORE risk is equal or exceeds 5 % or if there is established vascular disease or diabetes with end organ damage : Prescribe ASA, Statin, ACEI or ARB. Consider a pharmacological treatment to control hypertension and/or diabetes. It is not recommended to use the SCORE tables to monitor risk level when medical treatment has been initiated

21. « Systematic Cerebrovascular and cOronary Risk Evaluation » SCORE Canada website: www.scorecanada.caSCORE Canada website: www.scorecanada.ca/ « Systematic Cerebrovascular and cOronary Risk Evaluation »