CLINICAL QUESTION

Using demographic and laboratory data, what is the best way to assess the likelihood that a patient will experience a cardiovascular event in the next 10 or 30 years?

EVIDENCE SUMMARY

Recommendations regarding the use of statins, antihypertensives, and aspirin have increasingly relied on an initial assessment of cardiovascular risk.^1–4 The Framingham Risk Score was developed using data from the 1960s and 1970s in a relatively homogenous population in Massachusetts and was one of the first risk scores to quantify lifetime cardiovascular risk.⁵ It is limited by the homogeneity of the population and that type 2 diabetes mellitus was less common, tobacco use was more common, and treatment of lipid disorders and hypertension was less widespread.⁶

Since 2013, guidelines from the National Heart, Lung, and Blood Institute and the American Heart Association have recommended the use of the Pooled Cohort Equations.¹ These were developed from several cohorts that had greater diversity and more closely reflected contemporary practices regarding management of cardiovascular risk factors. However, studies have shown that the Pooled Cohort Equations tend to systematically overestimate cardiovascular risk by as much as 40%.⁷ This could result in inappropriately intensive treatment for many patients, leading to higher costs and a greater risk of adverse events.