When to remeasure cardiovascular risk in untreated people at low and intermediate risk: Observational study

Katy J L Bell, Andrew Hayen, Les Irwig, Osamu Takahashi, Sachiko Ohde, Paul Glasziou

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Abstract

Objective: To estimate the probability of becoming high risk for cardiovascular disease among people at low and intermediate risk and not being treated for high blood pressure or lipid levels. Design: Observational study. Setting: General communities in Japan and the United States. Participants: 13 757 participants of the Tokyo health check-up study and 3855 of the Framingham studies aged 30-74 years with complete data on risk equation covariates, not receiving blood pressure or cholesterol lowering treatment, and with an estimated risk of cardiovascular disease <20% within 10 years. We stratified participants on the basis of baseline risk: <5%, 5-<10%, 10-<15%, and 15-<20%. We used follow-up measurements from the Tokyo study done annually over three years (2006-10) and follow-up visits in the Framingham study done between eight (1968-75) and 19 years (1990-1995) after baseline. Main outcome measure: Estimated 10 year risk of a cardiovascular event >20% using the Framingham equation. Results: At baseline most participants had <5% risk (60.6% of Tokyo cohort and 45.7% of Framingham cohort) or 5-<10% risk (24.0% and 28.0%, respectively) of a cardiovascular event within 10 years. There was <10% probability of crossing the treatment threshold at 19, 8, and 3 years for baseline risk groups <5%, 5-<10%, and 10-<15%, respectively, and >10% probability of crossing the treatment threshold at one year for the 15-<20% baseline risk group. Conclusions: Decisions on the frequency of remeasuring for cardiovascular risk should be made on the basis of baseline risk. Repeat risk estimation before 8-10 years is not warranted for most people initially not requiring treatment. However, remeasurement within a year seems warranted in those with an initial 15-<20% risk.

Original languageEnglish
Article numberf1895
JournalBritish Medical Journal
Volume346
Issue number7906
DOIs
Publication statusPublished - 4 May 2013

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Observational Studies
Cardiovascular Diseases
Tokyo
Japan
Cholesterol
Blood Pressure
Hypertension
Lipids
Health

Cite this

Bell, Katy J L ; Hayen, Andrew ; Irwig, Les ; Takahashi, Osamu ; Ohde, Sachiko ; Glasziou, Paul. / When to remeasure cardiovascular risk in untreated people at low and intermediate risk : Observational study. In: British Medical Journal. 2013 ; Vol. 346, No. 7906.
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abstract = "Objective: To estimate the probability of becoming high risk for cardiovascular disease among people at low and intermediate risk and not being treated for high blood pressure or lipid levels. Design: Observational study. Setting: General communities in Japan and the United States. Participants: 13 757 participants of the Tokyo health check-up study and 3855 of the Framingham studies aged 30-74 years with complete data on risk equation covariates, not receiving blood pressure or cholesterol lowering treatment, and with an estimated risk of cardiovascular disease <20{\%} within 10 years. We stratified participants on the basis of baseline risk: <5{\%}, 5-<10{\%}, 10-<15{\%}, and 15-<20{\%}. We used follow-up measurements from the Tokyo study done annually over three years (2006-10) and follow-up visits in the Framingham study done between eight (1968-75) and 19 years (1990-1995) after baseline. Main outcome measure: Estimated 10 year risk of a cardiovascular event >20{\%} using the Framingham equation. Results: At baseline most participants had <5{\%} risk (60.6{\%} of Tokyo cohort and 45.7{\%} of Framingham cohort) or 5-<10{\%} risk (24.0{\%} and 28.0{\%}, respectively) of a cardiovascular event within 10 years. There was <10{\%} probability of crossing the treatment threshold at 19, 8, and 3 years for baseline risk groups <5{\%}, 5-<10{\%}, and 10-<15{\%}, respectively, and >10{\%} probability of crossing the treatment threshold at one year for the 15-<20{\%} baseline risk group. Conclusions: Decisions on the frequency of remeasuring for cardiovascular risk should be made on the basis of baseline risk. Repeat risk estimation before 8-10 years is not warranted for most people initially not requiring treatment. However, remeasurement within a year seems warranted in those with an initial 15-<20{\%} risk.",
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When to remeasure cardiovascular risk in untreated people at low and intermediate risk : Observational study. / Bell, Katy J L; Hayen, Andrew; Irwig, Les; Takahashi, Osamu; Ohde, Sachiko; Glasziou, Paul.

In: British Medical Journal, Vol. 346, No. 7906, f1895, 04.05.2013.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - When to remeasure cardiovascular risk in untreated people at low and intermediate risk

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AU - Bell, Katy J L

AU - Hayen, Andrew

AU - Irwig, Les

AU - Takahashi, Osamu

AU - Ohde, Sachiko

AU - Glasziou, Paul

PY - 2013/5/4

Y1 - 2013/5/4

N2 - Objective: To estimate the probability of becoming high risk for cardiovascular disease among people at low and intermediate risk and not being treated for high blood pressure or lipid levels. Design: Observational study. Setting: General communities in Japan and the United States. Participants: 13 757 participants of the Tokyo health check-up study and 3855 of the Framingham studies aged 30-74 years with complete data on risk equation covariates, not receiving blood pressure or cholesterol lowering treatment, and with an estimated risk of cardiovascular disease <20% within 10 years. We stratified participants on the basis of baseline risk: <5%, 5-<10%, 10-<15%, and 15-<20%. We used follow-up measurements from the Tokyo study done annually over three years (2006-10) and follow-up visits in the Framingham study done between eight (1968-75) and 19 years (1990-1995) after baseline. Main outcome measure: Estimated 10 year risk of a cardiovascular event >20% using the Framingham equation. Results: At baseline most participants had <5% risk (60.6% of Tokyo cohort and 45.7% of Framingham cohort) or 5-<10% risk (24.0% and 28.0%, respectively) of a cardiovascular event within 10 years. There was <10% probability of crossing the treatment threshold at 19, 8, and 3 years for baseline risk groups <5%, 5-<10%, and 10-<15%, respectively, and >10% probability of crossing the treatment threshold at one year for the 15-<20% baseline risk group. Conclusions: Decisions on the frequency of remeasuring for cardiovascular risk should be made on the basis of baseline risk. Repeat risk estimation before 8-10 years is not warranted for most people initially not requiring treatment. However, remeasurement within a year seems warranted in those with an initial 15-<20% risk.

AB - Objective: To estimate the probability of becoming high risk for cardiovascular disease among people at low and intermediate risk and not being treated for high blood pressure or lipid levels. Design: Observational study. Setting: General communities in Japan and the United States. Participants: 13 757 participants of the Tokyo health check-up study and 3855 of the Framingham studies aged 30-74 years with complete data on risk equation covariates, not receiving blood pressure or cholesterol lowering treatment, and with an estimated risk of cardiovascular disease <20% within 10 years. We stratified participants on the basis of baseline risk: <5%, 5-<10%, 10-<15%, and 15-<20%. We used follow-up measurements from the Tokyo study done annually over three years (2006-10) and follow-up visits in the Framingham study done between eight (1968-75) and 19 years (1990-1995) after baseline. Main outcome measure: Estimated 10 year risk of a cardiovascular event >20% using the Framingham equation. Results: At baseline most participants had <5% risk (60.6% of Tokyo cohort and 45.7% of Framingham cohort) or 5-<10% risk (24.0% and 28.0%, respectively) of a cardiovascular event within 10 years. There was <10% probability of crossing the treatment threshold at 19, 8, and 3 years for baseline risk groups <5%, 5-<10%, and 10-<15%, respectively, and >10% probability of crossing the treatment threshold at one year for the 15-<20% baseline risk group. Conclusions: Decisions on the frequency of remeasuring for cardiovascular risk should be made on the basis of baseline risk. Repeat risk estimation before 8-10 years is not warranted for most people initially not requiring treatment. However, remeasurement within a year seems warranted in those with an initial 15-<20% risk.

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DO - 10.1136/bmj.f1895

M3 - Article

VL - 346

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

SN - 0959-535X

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