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).

• 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.

How to use these tables

This page is set to use frames to display the key in the lower part of your browser's window. If your browser doesn't support frames or tables with coloured cell backgrounds, click here and you'll get them as gifs.

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.

		No Diabetes												Diabetes
		Non-Smoker						Smoker						Non-Smoker						Smoker
AGE	B.P.	Total Chol.:HDL-Chol												Total Chol.: HDL-Chol.
		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8
70	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
60	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
50	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
40	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8
AGE	B.P.	Total Chol.:HDL-Chol												Total Chol.: HDL-Chol.

Absolute risk of CVD in Women

		No Diabetes												Diabetes
		Non-Smoker						Smoker						Non-Smoker						Smoker
AGE	B.P.	Total Chol.:HDL-Chol												Total Chol.: HDL-Chol.
		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8
70	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
60	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
50	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
40	180/105	*	*	*	*	*		*	*	*	*	*		*	*	*	*	*		*	*	*	*	*
	160/95	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	140/85	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
	120/75	.	.	.	.	*		.	.	.	.	*		.	.	.	.	*		.	.	.	.	*
		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8		4	5	6	7	8
AGE	B.P.	Total Chol.:HDL-Chol												Total Chol.: HDL-Chol.

References

1. Anderson KV, Odell PM, Wilson PWF, Kannel WB. Cardiovascular disease risk profiles. Am Heart J 1991;121:293-8.
2. &QUOT;Guidelines for the management of mildly raised blood pressure in New Zealand&QUOT;, a bulletin published by the National Health Committee, Ministry of Health, PO Box 5013,Wellington, New Zealand (ISBN 0-477-01740-1)
3. Dyslipidaemia Advisory Group. 1996 National Heart Foundation clinical guidelines for the assessment and management of dyslipidaemia. NZ Med J 1996;109:224-32.
4. Insua JT, Sacks HS, Lau T, et al. Drug treatment of hypertension in the elderly: a meta-analysis. Ann Intern Med 1994;121:355-62.
5. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival (4S) Study. Lancet 1994;344:1383-89.
6. Shepherd J, Cobbe S, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995;333:1301-7.
7. Crouse J, Byington R, Hoen H, Furberg C. Reductase inhibitor monotherapy and stroke prevention. Arch Intern Med 1997;157:1305-10.
8. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996;335:1001-9.