The Cochrane Database of Systematic Reviews contains several reviews of interventions to prevent cardiovascular disease such as medications, diet and exercise. A precursor to trying these might be to assess a person’s risk and a new review in March 2017 looks at the evidence for using risk scores to do this. Lead author, Kunal Karmali from the Northwestern University Feinberg School of Medicine in Chicago USA, tells us more in this podcast.
John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The Cochrane Library contains several reviews of interventions to prevent cardiovascular disease such as medications, diet and exercise. A precursor to trying these might be to assess a person’s risk and a new review in March 2017 looks at the evidence for using risk scores to do this. Lead author, Kunal Karmali from the Northwestern University Feinberg School of Medicine in Chicago USA, tells us more in this podcast.
Kunal: Guidelines for the prevention of cardiovascular disease emphasize risk scores as a guide for clinical decision-making, particularly with preventive medications. These risk scores use clinical variables like age, sex, blood pressure, and cholesterol levels to estimate the chance that someone will have a heart attack or stroke. And, although there has been much research into the development of risk scores, there is uncertainty about the actual clinical benefits of providing this information in practice.
Therefore, to help resolve this uncertainty, we investigated the effects of evaluating and providing risk scores on cardiovascular outcomes and on the levels of risk factors like cholesterol and blood pressure. We also looked at other outcomes such as the prescribing of preventive medications, medication adherence, healthy behaviors, decisional conflict, health-related quality of life, and healthcare costs.
We identified a total of 41 randomized trials involving nearly 200,000 participants that compared the provision of a risk score by a doctor, healthcare professional, or healthcare system with usual care without the risk score. Overall, the evidence was of low quality for answering our key questions but it suggests that providing risk scores may have a small effect on reducing both cholesterol, by 0.10 mmol/L, and systolic blood pressure, by 2.8 mmHg. However, there was insufficient high-quality evidence to determine whether this translates into the prevention of cardiovascular events, with only three studies reporting this endpoint, which was our primary outcome for the review.
Looking to the secondary outcomes, providing risk scores may increase smoking cessation and reduce decisional conflict, but there was little or no effect on medication adherence or health-related quality of life. Data on costs were also limited but suggest a reduction in healthcare costs after providing risk scores.
In summary, we are unable to draw firm conclusions about the clinical effectiveness of providing risk scores in primary prevention. Much remains uncertain about the optimal implementation of risk scores in clinical practice to improve cardiovascular outcomes and risk factor levels. We’d like to see more research that identifies the optimal content and format of messages about cardiovascular risk that motivate behaviour change in physicians and patients. We’d also like to see more research that assesses the impact of providing this risk information over time, and looks beyond the simple initiation of risk-reducing therapies to assess uptake and long-term adherence to these therapies to improve cardiovascular health.”
John: If you would like to look in more depth at the findings of the review and the content of the 41 included studies, you can find full details online if you go to Cochrane Library dot com and search ‘risk scores and CVD’.