For the first time, African-Americans can receive an individually tailored snapshot of their cardiovascular risk, and both heart attack and stroke risk can be measured at the same time.
These achievements are thanks to new guidelines issued in November by the American Heart Association and American College of Cardiology that give doctors a new formula for identifying who is most at risk for a heart attack or stroke.
Updated risk equations for non-Hispanic white men and women – and the first-ever risk equations for African-American men and women – are based on the latest findings from research studies that have followed roughly 25,000 people. There is not yet enough data available for Hispanics/Latinos, but this will be a goal in the future.
Until now, doctors have relied on risk equations based on long-term research in whites, a population at less risk for heart attack and stroke than African-Americans.
Going forward, doctors will also no longer be hamstrung by risk equations that only calculate the threat of heart disease but not stroke.
“A lot of people were being left behind in terms of understanding their stroke risk,” said Donald Lloyd-Jones, M.D., co-chair of the committee that wrote the new guidelines. Women and African-Americans are especially at risk for stroke, he said.
The guidelines call for healthcare systems and providers to immediately adopt the new risk equations. People ages 40 to 79 should have their 10-year risk calculated every four to six years.
The equation includes race, gender, age, total cholesterol, HDL (good) cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status.
“That’s it. Nothing that requires anything more than a visit to your healthcare provider and a fasting blood draw,” said David Goff, Jr., M.D., Ph.D., fellow co-chair of the guidelines committee and dean of the Colorado School of Public Health in Aurora.
If risk is still not clear after the assessment, doctors can use any of four “tiebreaker” risk markers, the simplest being a history of premature cardiovascular disease in a parent, sibling or child. The other additional risk markers are ankle-brachial index, high-sensitivity C-reactive protein and coronary artery calcium score.
The new equations allow doctors to be smarter about who should receive medications to lower cardiovascular risk. Nearly a third of U.S. adults are at high enough risk for a heart attack or stroke that they would benefit from cholesterol-lowering statin drugs, according to a companion guideline on cholesterol that recommends statins for people with a risk of having a cardiovascular event, including stroke, of at least 7.5 percent within the next decade.
“The higher someone’s risk, the more likely that person is to benefit from being on a medication,” said Lloyd-Jones, a preventive cardiologist at Northwestern University Feinberg School of Medicine in Chicago.
A separate equation is available to estimate a person’s lifetime risk, which is recommended for people ages 20 to 59. Previous risk equations that have only considered a person’s risk within the next decade have been misleading for young adults since they have a very low 10-year risk, but have great potential to prevent atherosclerosis (hardening of the arteries) and subsequent heart attacks, strokes and their complications, Goff said.
“This new guideline includes an approach to help young adults know their long-term risk so they can do something about it earlier in life when lifestyle changes can make a huge difference,” Goff said. This is especially important, he added, since many first heart attacks and strokes are deadly.
About 610,000 Americans have a first stroke every year. Another 525,000 have a first heart attack.
More research is needed before risk equations can be developed for Latinos and Asian-Americans. For now, the guidelines suggest doctors use the risk equations for all adults, with the understanding that risk may be overestimated, especially for Asian-Americans.
Only about 10 percent of the U.S. population is at a low lifetime risk for heart attack and stroke, Goff said. “For the other 90 percent, there’s tremendous opportunity for them to take control of their own destiny.”
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