Estimating CVD risk and treatment benefit
- How to use these colour charts
- Men with no diabetes
- Men with diabetes
- Women with no diabetes
- Women with diabetes
| Non- smoker |
Smoker | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4 | 5 | 6 | 7 | 8 | 4 | 5 | 6 | 7 | 8 | |||
| Blood pressure | 180/105 | AGE 70 | ||||||||||
| 160/95 | ||||||||||||
| 140/85 | ||||||||||||
| 120/75 | ||||||||||||
| 180/105 | AGE 60 | |||||||||||
| 160/95 | ||||||||||||
| 140/85 | ||||||||||||
| 120/75 | ||||||||||||
| 180/105 | AGE 50 | |||||||||||
| 160/95 | ||||||||||||
| 140/85 | ||||||||||||
| 120/75 | ||||||||||||
| 180/105 | AGE 40 | |||||||||||
| 160/95 | ||||||||||||
| 140/85 | ||||||||||||
| 120/75 | ||||||||||||
| 4 | 5 | 6 | 7 | 8 | 4 | 5 | 6 | 7 | 8 | |||
| Ratio of Total Cholesterol: HDL | ||||||||||||
| Risk level | Benefit:* CVD events prevented per 100 treated over 5 years | |||
|---|---|---|---|---|
| 5 year CVD risk (non-fatal and fatal) | Mid-range value (range) | One intervention Estimated ARR 25% | Two interventions Estimated ARR 45% | Three interventions Estimated ARR 55% |
| Very high | > 30% | > 8 | > 14 | > 17 |
| Very high | 27.5% (25-30%) | 7 | 12 | 15 |
| Very high | 22.5% (20-25%) | 6 | 10 | 12 |
| High | 17.5% (15-20%) | 4 | 8 | 10 |
| Moderate | 12.5% (10-15%) | 3 | 6 | 7 |
| Mild | 7.5% (5-10%) | 2 | 3 | 4 |
| Mild | 2.75% (2.5-5%) | 0.7 | 1.2 | 1.5 |
| Mild | < 2.5% | < 0.6 | < 1.1 | < 1.4 |
| Risk level | Benefit:* NNT to prevent one event over 5 years | |||
|---|---|---|---|---|
| 5 year CVD risk (non-fatal and fatal) | Mid-range value (range) | One intervention 1/ARR | Two interventions 1/ARR | Three interventions 1/ARR |
| Very high | > 30% | < 13 | < 7 | < 6 |
| Very high | 27.5% (25-30%) | 15 | 8 | 7 |
| Very high | 22.5% (20-25%) | 18 | 10 | 8 |
| High | 17.5% (15-20%) | 23 | 13 | 10 |
| Moderate | 12.5% (10-15%) | 32 | 18 | 15 |
| Mild | 7.5% (5-10%) | 53 | 30 | 24 |
| Mild | 2.75% (2.5-5%) | 145 | 81 | 66 |
| Mild | < 2.5% | > 160 | > 89 | > 73 |
| ARR, absolute risk reduction | ||||
Assumptions:
Notes
*Assumptions: A conservative estimate that each intervention: aspirin, blood pressure treatment (lowering systolic BP by 10 mm Hg) or lipid modification (lowering LDLC by 20%) reduces cardiovascular risk by about 25% over 5 years. The relative risk of a CVD event over 5 years after one intervention compared to no treatment is 0.75, after two is 0.75 x 0.75, and after three is 0.75 x 0.75 x 0.75 (i.e. the risk is multiplicative).
(1) People with a strong history of CVD (first degree male relatives with CVD before 55 years, female relatives before 65 years) or obesity (body mass index above 30 kg/m2) are likely to be at greater risk than the tables indicate. The magnitude of the independent predictive value of these risk factors remains unclear their presence should influence treatment decisions for patients at borderline treatment levels. (2) If total cholesterol or total cholesterol : HDL ratio is greater than 8 then the risk is at least 15%. (3) Nearly all people aged 75 years or over also have an absolute cardiovascular risk over 15%.
Charts reproduced with permission from The National Heart Foundation of New Zealand. Also available on http://www.nzgg.org.nz/guidelines/0035/CVD_Risk_Full.pdf