The prognostic tables below are based on Framingham Study data and are derived from a published equation predicting total CVD risk (1). The treatment recommendations are derived from New Zealand guidelines on the management of raised blood pressure (2) and New Zealand guidelines on the management of dyslipidaemia (3).

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• How to use these tables
  1. Assessment of Absolute Risk of CVD Event
  2. Benefits of Treatment
• Table of CVD Risk for Men
• Table of CVD Risk for Women
• References
• Inclusion criteria for these data.

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Assessment of Absolute Risk of Cardiovascular Event

A major CVD event is defined as a coronary-related death, myocardial infarction (MI), new angina, a stroke or TIA, or the development of congestive heart failure or peripheral vascular syndrome.

1. Group A: defined clinically at very high risk (>20%); risk tables unnecessary.
   • Patients with manifest cardiovascular disease:
     1. clinically proven coronary heart disease;
     2. angioplasty or coronary artery bypass grafts;
     3. ischaemic stroke or atherosclerotic TIAs;
     4. proven intermittent claudication from peripheral vascular disease.
   • Patients with genetic lipid disorders.
   • Patients with diabetic nephropathy (albuminuria >300mg/day).
2. Groups B, C D, E: defined using risk tables.
   • Identify the table relating to the person's sex, diabetic status, smoking status and age (age shown is the mean for that category, e.g. age 60 = 55-65 years).
   • Within the table find the cell nearest to the person's blood pressure and the total cholesterol:HDL ratio.
   • Compare cell with the risk level key and categorise risk for treatment decisions as B (very high risk, >20%), C (high risk, 15-20%), D (moderate risk, 10-15%), or E (mild risk, <10%).

   • diabetes status defined as: on insulin, oral hypoglycaemics, or fasting blood glucose > 8.0 mmol/L - Reflotron or laboratory measurement;
   • BP taken as mean of two readings on each of two occasions is sufficient for assessing risk but not for establishing pre-treatment baseline);
   • total cholesterol:HDL ratio taken as mean of two non-fasting Reflotron measurements or one laboratory measurement is sufficient for assessing risk but not for establishing pre-treatment baseline).

3. If total cholesterol or total cholesterol:HDL ratio >8, the person is classified at least as high risk.
4. For age >75 the absolute risk of CVD is >15% in nearly all individuals.
5. Other important CVD factors not included in the risk tables are family history of CVD, physical inactivity, obesity, left ventricular hypertrophy. The presence of these factors should influence treatment decisions for patients at borderline treatment levels.

Benefit of Treatment

Assumes that BP reduction of about 12 / 6 mmHg in patients with BP > 140-150 / 90 mmHg, or cholesterol reduction of about 20% in patients with total cholesterol > 5.0-5.5 mmol/L, produces an approximate 30% reduction in CVD risk, whatever the pre-treatment absolute risk.

Read off estimated benefit from colour code in key to table. Benefit is expressed as:

1. number of events prevented per 100 patients treated for 5 years;
2. NNT for 5 years to prevent one event.

Men

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Women

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	Prognosis	Benefit 1	Benefit 2
	5 yr CVD risk (non-fatal and fatal)	CVD events prevented per 100 treated for 5 yrs**	NNT for 5 years**
	> 30%	> 10 per 100	<10		Suggested starting point for discussion with patient about drug treatment
	25-30%	9 per 100	11
	20-25%	7.5 per 100	13
	15-20%	6 per 100	16
	10-15%	4 per 100	25
	5-10%	2.5 per 100	40
	2.5-5%	1.25 per 100	80
	<2.5%	<0.8 per 100	> 120

*	cells with this marker indicate that in patients with very high levels of cholesterol (> about 8.5-9 mmol/L) or blood pressure (> about 170 / 100 mmHg), the risk equations may underestimate the true risk. Therefore it is recommended that treatment be considered at lower absolute CVD risks than in other patients.
**	assumes BP reduction of about 12 / 6 mmHg in patients with BP > 140-150 / 90, or cholesterol reduction of about 20% in patients with total cholesterol > 5.0-5.5 mmol/L, produces an approximate 30% reduction in CVD risk, whatever the pre-treatment absolute risk.

References: