What are the differences in lipid management recommendations between CVD risk scores?

Updated: Nov 30, 2018
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Answer

Two separate studies in 2014 compared the ACC/AHA-ASCVD risk estimator and SCORE in European cohorts. In the first study, which used data from a Dutch cohort 55 years of age and older, the percentages of patients would be eligible for statin therapy, according to the various algorithms, were as follows [19] :

  • ACC/AHA-ASCVD:  96.4% of men and 65.8% of women
  • SCORE: 66.1% of men and 39.1% of women
  • FRS-ATP-III 52.0% of men and 35.5% of women

Similarly, in a separate study of a Swiss cohort 50 years and older, the investigators reported that 30 times the number of men were eligible for statin therapy using the ACC/AHA-ASCVD risk estimation as compared with SCORE. In the 60-70 year old age group, twice as many men and six times as many women were considered at high risk. [20]

A 2012 study of men (aged 50-79) and women (aged 47-79) nm ). In general, the RSS predicted increased risk in women and decreased risk in men. The authors concluded that adopting the RRS for the screening of US adults would result in increased clinical management in 1.6 million women and decreased management in 2.10 million men. [21]

A 2014 study comparing the validity of three CVD risk algorithms in a middle-income Asian population in Malaysia found agreement in risk assessment between the US-developed FRS and the European-developed Systematic Coronary Risk Evaluation (SCORE), but the SCORE model was more accurate for predicting risk in men while the FRS was better at predicting risk in women. A third algorithm (World Health Organization/International Society of Hypertension score) performed poorly with both men and women. [22]


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