Cardiovascular Disease in Women Module III: Risk Assessment Tool This slide set was updated April 2008.

Risk Stratification: High Risk Diabetes mellitus Documented atherosclerotic disease Established coronary heart disease Peripheral arterial disease Cerebrovascular disease Abdominal aortic aneurysm Includes many patients with chronic kidney disease, especially ESRD 10-year Framingham global risk > 20%, or high risk based on another population-adapted global risk assessment tool SLIDE INFORMATION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation 2007; 115: 1481-501. Source: Mosca 2007

Risk Stratification: At Risk: > 1 major risk factors for CVD, including: Cigarette smoking Hypertension Dyslipidemia Family history of premature CVD (CVD at < 55 years in a male relative, or < 65 years in a female relative) Obesity, especially central obesity Physical inactivity Poor diet Metabolic syndrome Evidence of subclinical coronary artery disease (eg coronary calcification), or poor exercise capacity on tredtmill test or abnormal heart rate recovery after stopping exercise SLIDE INFORMATION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation 2007; 115: 1481-501. Source: Mosca 2007

Definition of Metabolic Syndrome in Women Abdominal obesity - waist circumference > 35 in. High triglycerides ≥ 150mg/dL Low HDL cholesterol < 50mg/dL Elevated BP ≥ 130/85mm Hg Fasting glucose ≥ 100mg/dL SLIDE INFORMATION SOURCE: Grundy SM, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 2005, accessed at www.circulationaha.org on October 25, 2005. The metabolic syndrome is characterized by a constellation of risk factors in one individual. This syndrome increases the risk for CHD at any given LDL-cholesterol level (1). The definition of metabolic syndrome remains controversial. This is the AHA/NHLBI definition. Patients are diagnosed with metabolic syndrome when three of five criteria are met. Patients receiving drug treatment for elevated triglycerides, reduced HDL, hypertension, or high glucose meet the threshhold for each criteria. A cutoff of 31 inches waist circumference for Asian American women should be used(1) (1) Grundy SM, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 2005, accessed at www.circulationaha.org on October 25, 2005. Source: AHA/NHLBI 2005

Risk Stratification: Optimal risk: No risk factors Healthy lifestyle Framingham global risk < 10% SLIDE INFORMATION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation 2007; 115: 1481-501. Source: Mosca 2007

Risk Stratification Calculate 10 year risk for all patients with two or more risk factors that do not already meet criteria for CHD equivalent Use electronic calculator for most precise estimate: www.nhlbi.nih.gov/guidelines/cholesterol/index.htm SLIDE INFORMSTION SOURCE: Mosca L, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-693. Source: Mosca 2004

SLIDE INFORMATION SOURCE: http://www. nhlbi. nih SLIDE INFORMATION SOURCE: http://www.nhlbi.nih.gov/about/framingham/riskabs.htm, accessed on March 8, 2005. 10 year risk can also be calculated using a pen and paper method. The scoring is demonstrated on this slide and the subsequent one (1). (1) http://www.nhlbi.nih.gov/about/framingham/riskabs.htm, accessed on March 8, 2005. Source: http://www.nhlbi.nih.gov/about/framingham/riskabs.htm

SLIDE INFORMATION SOURCE: http://www. nhlbi. nih SLIDE INFORMATION SOURCE: http://www.nhlbi.nih.gov/about/framingham/riskabs.htm, accessed on March 8, 2005. 10 year risk can also be calculated using a pen and paper method. The scoring is demonstrated on this slide and the previous one (1). (1) http://www.nhlbi.nih.gov/about/framingham/riskabs.htm, accessed on March 8, 2005. Source: http://www.nhlbi.nih.gov/about/framingham/riskabs.htm

Downloadable Scoring Sheet for 10-year CHD event risk The scoring sheet is available at: www.nhlbi.nih.gov/about/framingham/riskabs.htm SLIDE INFORMATION SOURCE: www.nhlbi.nih.gov/about/framingham/riskabs.htm, accessed April 2, 2008. Source: www.nhlbi.nih.gov/about/framingham/riskabs.htm