Analysis and critical overview on on-line cardiovascular risk calculators Čavaljuga Semra, Ademović Enisa, Ibrahimović Lejla, Čelik Damir1, Veledar Emir2 Institute of Epidemiology and biostatistics, Faculty of Medicine, University of Sarajevo, BiH Emory University, Atlanta, georgia, USA

Risk calculators are a helping tool in quantification of risk of getting a cardiovascular disease in a certain period of time. There is no universal calculator that can be used on an entire world population. Risk assessment equations predict risk best in the type of population from which they were derived.

An aim of this study is: to represent characteristics of available cardiovascular risk calculators, explain the crucial differences among them and facilitate decision on which one of them to use in which cases.

Metods: Browsing on-line literature, available cardiovascular risk calculators, that are used to calculate cardiovascular risk in North America and Europe, were analyzed.

Results and discusion: Risk calculator of which are used to assess risk for North American populations (Framingham equation). Risk calculator of which are used to assess risk in European populations (BNF, ASSIGN, QRISK)

From The Framingham Heart Study Enter Values Here   Enter Values Here CHD(MI and Coronary Death) Risk Prediction National Cholesterol Education Program Adult Treatment Panel III Risk Factor Units (Type Over Placeholder Values in Each Cell) Notes Gender male (m) or female (f) f Age years 70 Total Cholesterol mg/dL 130 HDL 60 Systolic Blood Pressure mmHg 119 Treatment for Hypertension {Only if SBP>120} yes (y) or no (n) n Current Smoker y Time Frame for Risk Estimate 10 years 10 Your Risk (The risk score shown is derived on the basis of an equation. Other NCEP materials, such as ATP III print products, use a point-based system to calculate a risk score that approximates the equation-based one.) 0,03 3% If value is < the minimum for the field, enter the minimum value. If value is > the maximum for the field, enter the maximum value. These functions and programs were prepared by Ralph B. D'Agostino, Sr., Ph.D. and Lisa M. Sullivan, Ph.D., Boston University and The Framingham Heart Study and Daniel Levy, M.D., Framingham Heart Study, National Heart, Lung and Blood Institute. Your Risk Estimate, Comparative Risks for Lowest = Total Chol<160, HDL>60, Optimal SBP (<120), No Trt for Htn, Non-Smoker Same Age and Gender Low = Total Chol 160-199, HDL 50-59, Normal SBP (<130), No Trt for Htn, Non-Smoker

JBS/BNF

ASSIGN kalkulator

QRISK®2 kalkulator

Basic differences among them are related to the time period for which the risk is being calculated, patient’s age range, cigarette smoking, diabetes, family history, presence of left ventricular hypertrophy, definition of blood cholesterol values, comorbidity, definition of blood pressure values.

What does mean if someone has a 10 year QRisk score of 20%? If someone has a 10 year QRisk score of 20% then in a crowd of 100 people like them, on average 20 people would get cardiovascular disease over the next 10 years. Or put another way, they have a ‘one in five’ chance of getting cardiovascular disease over the next 10 years.

Conclusion There are differences among different risk calculators; it is the definition of cardiovascular diseases in the first place (Original Framinghman definition, JBS definition, ASSIGN definition…), and the risk factors included in calculation. From the very first risk calculators, constructed after the end of the first phase of Framingham study in 1980s, until today, risk calculators have changed over time, in order to reflect properly the population changes.

It is essential to emphasize that risk calculators are designed as an aid in clinical decision-making, and should not in any case neglect the clinical judgement of a patient.

Thank you!!!