Good day!
I am looking for a risk stratification tool that can identify high-risk individuals among those with diagnosed/subclinical hypertension, diabetes mellitus, and/or dyslipidemia. Ideally, the tool is age-standardized, region-specific (Asia/SE Asia in my case), easy to utilize, and cost-effective, but it's not necessary to fulfill the first two criteria.
I have looked into SCORE2, MUS, etc., but most of these models are appropriate only for apparently healthy individuals. WHO cardiovascular risk stratification charts are useful but their use is limited only to patients aged 40-75 y/o.
So far, it appears my best candidate would be the risk stratification heat map presented in the 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension since it encompasses the three cardiometabolic conditions I've specified.
I would just like to ask if you could recommend a more optimal risk stratification tool than the heat map I've mentioned? Thank you very much!
In my opinion you could review the following risk stratification systems: in 2023-ESH Guidelines, 2024 ESC Guidelines (based on SCORE with the some modifications), ASCVD Risk calculator. I guess, there are very useable tools for the comprehensive CVD risk evaluation. Naturally, you could add any additional factor or the laboratory (instrumental) index for your personal purpose, but you will receive the comparable results with other studies.
Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator from the American College of Cardiology. Linked here: https://www.mdcalc.com/calc/3398/ascvd-atherosclerotic-cardiovascular-disease-2013-risk-calculator-aha-acc?utm_source=chatgpt.com
For patients falling outside the ages of 40 to 79, or patients with an LDL above 190 mg/dL, the QRISK3 calculator or the Framingham Risk Score may be a better fit.
Additional option to look into:
Pooled Cohort Equations with Modifications (for example the China-PAR)
RECODe (Risk Equation for Complications of Diabetes)
A combination of these could make for a robust model that specifically meets your needs.
The QRISK3 tool is recommended for assessing cardiovascular risk in individuals with hypertension, diabetes, or dyslipidemia.
All that is needed to accurately predict the population at risk of atherothrombotic disease (ATD) is a full lipid panel (LDL-c and HDL-c), knowledge of cigarette smoking status, and systolic blood pressure. These risk factors are interdependent--hence the lipids must be considered in terms of a ratio and my preferred ratio is the Cholesterol Retention Fraction, defined as (LDL-c minus HDL-c)/LDL_-c. The reference is "The Prediction of the Population at Risk of Atherothrombotic Disease: Back to Framingham." by me, in EC Cardiology,7.3 (2020):1-19. QRISK is good but uses the CT:HDL-c ratio, which has three problems: 1) It incorporates TG, which have no direct role in ATD, 2) It predicts better and better as as the ratio's value rises, but in progressively fewer people, and 3) HDL-c is in the denominator, which reduces its reproducibility. (Remember that HDL-c is the most difficult of the lipid moieties to measure.) The Sheffield tables are good to, but with the same problems.
For individuals with hypertension, diabetes, and/or dyslipidemia, the ASCVD Risk Calculator (Atherosclerotic Cardiovascular Disease Risk Calculator) is highly recommended. It estimates the 10-year and lifetime risk of cardiovascular events based on factors like age, blood pressure, cholesterol levels, diabetes, and smoking status.
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