Quitting smoking, losing weight, getting enough exercise and eating a healthy diet can really reduce the risk of cardiovascular disease
The model that GPs use to predict the likelihood that someone will develop a cardiovascular disease within ten years underestimates the number of people who will actually develop it. The risk is one and a half times greater than expected by the model, according to a study by Radboud university medical center. This model was compared with the actual number of cardiovascular diseases.
The risk of someone without cardiovascular disease developing a cardiovascular disease within ten years is calculated using various models. In the Netherlands, an adaptation of the SCORE model is used according to the guideline. This model predicts the risk of cardiovascular disease based on factors such as age, gender, smoking, blood pressure and cholesterol.
Researchers at Radboudumc, led by epidemiologist Marion Biermans, have now looked at the predictive value of various models. They followed a group of patients without a history of cardiovascular disease, where the GP had measured all risk factors. According to the modified SCORE model, the risk of cardiovascular disease was 12.2 percent. In practice, however, 18.6 percent of this group suffered a heart attack or other cardiovascular disease within ten years. That is one and a half times as large as might be assumed on the basis of the current model.
A huge difference, says Biermans, who is affiliated with the Department of Primary Care. She has an explanation for the difference: ‘The model is based on a healthy general population. But that is not the group of people who come to the doctor, you only come there with certain complaints. That is why we looked at how the model is used in daily practice, with people whose cholesterol and other values have been determined by the doctor.’
Modify the models
That is why Biermans advocates adapting the model. ‘We need to move towards a model in which specific data from GP practices are included. That gives doctors a much more reliable picture of the risk that people run.’ GPs use the model to discuss the risk of cardiovascular disease with their patients and then jointly decide on treatment, such as smoking cessation, weight loss and medication.
But models and guidelines don’t change overnight. That is why Biermans hopes that with this knowledge, patients will receive better guidance and follow-up on lifestyle changes and, if necessary, receive medication in a timely manner. ‘If patients and doctors are now hesitant and hesitant to treat, that could mean undertreatment.’ Finally, she emphasizes the importance of a healthy lifestyle: ‘Patients can also make a difference themselves by improving their lifestyle. Quitting smoking, losing weight, getting enough exercise and eating a healthy diet can really reduce the risk of cardiovascular disease.’
About this publication
Deze publicatie verscheen in British Journal of General Practice: Performance of the SCORE and Globorisk cardiovascular risk prediction models: a prospective cohort study in Dutch general practice
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