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Reynolds Risk
Score at a glance
The seven criteria that
determine a woman's heart risk score are:
- Age
- Current smoking status: the
most definitive risk factor
- Systolic blood pressure:
the upper blood pressure measurement, regardless
if BP medications are being taken; for most
women, the optimal systolic BP value is less
than 120 mm/Hg
- Total cholesterol: the average
of two measurements from a standard blood test
is recommended; for most women, the optimal
value is less than 160 mg/dL
- High-density lipoprotein
cholesterol: the average of two measurements
from a standard blood test is recommended; for
most women, the optimal value is greater than
60 mg/dL
- High-sensitivity C-reactive
protein: the lower of two measurements from
a standard blood test is recommended, particularly
if the initial value is greater than 5 mg/L;
for most women, the optimal value is less than
0.5 mg/L
- Parental history of myocardial
infarction: the test considers parental history
positive if either parent suffered an MI before
age 60
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American researchers have devised
a simple but innovative test that could help physicians
better predict women's odds of developing heart disease.
Standard methods of risk assessment
developed decades ago were generally patterned on male
population models. They've proven less effective at
determining whether a woman will develop heart disease
— particularly the millions of women considered
to be at intermediate risk, for whom preventive treatment
is not standardized. But using the Reynold's Risk Score
would reclassify 50% of those women into more well-defined
high- or low-risk categories, allowing for more effective
treatment. "[The test] lets doctors know which risk
factors need to be targeted most, and how aggressively
they need to be treated," said Dr Samia Mora, a cardiologist
and member of the research team led by Dr Paul Ridker
at Brigham and Women's Hospital, Boston.
TWO
TO TANGO
According to its developers, the test's increased accuracy
is due to the inclusion of two new risk predictors:
high-sensitivity C-reactive protein and parental history
of myocardial infarction before age 60.
"These two, easily determined risk
factors — when taken with traditional factors —
give us a lot more information about a woman's chances
of getting heart disease in the next 10 or more years
It's almost like looking into her future and being able
to stop a heart attack or stroke before it happens,"
Dr Mora explained.
The Reynold's Risk Score is based
on information culled from the Women's Health Study.
Dr Ridker's team studied over 24,000 initially healthy
participants, choosing those over age 45 without diabetes.
Follow-up was an average of 10.2 years. Researchers
used information from two-thirds of the group to create
the risk score and the remaining one-third to validate
its conclusions. Their findings were published in the
February 14 issue of JAMA.
MAKING
THE CUT
Dr Ridker's team originally looked at 35 variables —
some traditional, others controversial. "Previous studies
made assumptions of which factors to include when assessing
risk. We included all of them to determine which ones
were actually predictive of cardiovascular events in
women," said Dr Mora, adding that smoking is still the
most important risk factor.
Most of the risk factors they looked
at didn't demonstrate a strong enough effect on the
incidence of heart disease. The only two new ones that
merited inclusion were C-reactive protein and family
history, though Dr Mora said a few, like lipoprotein-a,
made the short list. The other five standard risk factors
included in the score are age, smoking, systolic blood
pressure, total cholesterol and high-density lipoprotein.
"Previous risk assessment
models targeted high-risk individuals, who would be
started on medication, while everyone else would simply
be given general public health advice. This worked well
for women at low-risk, but we didn't know what to do
with all the intermediate-risk women — 10 million
in the US alone," explained Dr Mora. "With the Reynolds
Risk Score, we are able to reclassify a quarter of these
women as high-risk and another quarter as low-risk.
We know who will benefit from aggressive statin or aspirin
treatment, or for whom it would be sufficient to eat
a bit less and exercise a bit more," she added.
SEE
FOR YOURSELF
Take two women, both considered to be at intermediate
(5-20%) risk of developing heart disease according to
standard assessment. "If all of their variables are
equal, except one's high-sensitivity C-reactive protein
measurement is low and the other's is high, it may reclassify
them into low- and high-risk categories, respectively.
Instead of giving both of them medication or general
health advice, each woman receives the treatment that's
appropriate for her," said Dr Mora.
She encourages doctors to visit
ReynoldsRiskScore.org, to try the user-friendly application
for themselves — or plug in a patient's numbers
while they're still in your office. "You can show them
how — even if all their other risk factors stay
the same — the likelihood of a cardiovascular event
increases as they get older. Or demonstrate how their
risk can often be sharply decreased if they stop smoking
or reduce their blood pressure," said Dr Mora. If a
patient knows their real odds of developing heart disease,
she said, they will be more motivated to change their
risk profile.
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