I had replied to John rather than the list, but just in case people want to know more...

Kevin


Kevin McConway 
Professor of Applied Statistics
Department of Mathematics and Statistics 
Faculty of Mathematics, Computing and Technology
The Open University 
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-----Original Message-----
From: K.J.Mcconway 
Sent: 30 January 2012 14:48
To: 'John Bibby'
Subject: RE: Equation predicting 10-year risk of cardiovascular disease (10YRCARD) - where is it?

Hi John,

Well, how long is a piece of string...?

It depends which version they used. It was probably either Framingham (possibly modified) or QRISK. These use different inputs (QRISK has more) and different equations. No time to write much now, but useful info sources include the following:

NICE guideline at http://guidance.nice.org.uk/CG67 though you probably need to download the pdf version of it to get some of the relevant bits. But note that it says (in section 4.1) "There is an urgent need to establish which score is most acceptable for use in the population of England and Wales. NICE should review the relevant recommendations relating to risk assessment as soon as sufficient new data are available to address this." Currently they don't explicitly recommend any of them - they used to recommend Framingham but haven't done for a couple of years. 

Edinburgh CV risk calculator(s) at http://cvrisk.mvm.ed.ac.uk/ . This has implementations of Framingham, JBS which is a modification of Framingham, and ASSIGN which is "tailored to the Scottish population". The help pages are quite helpful.

QRISK at http://qrisk.org/ . This is based on lots of GP data from the UK. The website has links to lots of publications saying what they did (though the most obvious link on the front page seems not to work - go via the Publications button). Also http://www.qresearch.org/ which is the site for the research and database it's based on.

On statins, there's quite a bit in the NICE guideline I mention above (particularly if you get the "full" version of it, which is much longer and mentions much more research than the thing they call just the "NICE Guideline". And you should look at a Cochrane review, at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004816.pub4/abstract (plus links from there), which is a bit ambivalent about people with no actual signs of CV disease taking statins. Its "plain language summary" says:
"Cardiovascular disease (CVD) is ranked as the number one cause of mortality and is a major cause of morbidity world wide. Reducing high blood cholesterol which is a risk factor for CVD events is an important goal of medical treatment. Statins are the first-choice agents. Since the early statin trials were reported, several reviews of the effects of statins have been published highlighting their benefits particularly in people with a past history of CVD. However for people without a past history of CVD (primary prevention), the evidence is less clear. The aim of this systematic review is to assess the effects, both in terms of benefits and harms of statins for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE until 2007. We found 14 randomised control trials with 16 trial arms (34,272 patients) dating from 1994 to 2006. All were randomised control trials comparing statins with usual care or placebo. Duration of treatment was minimum one year and with follow up of a minimum of six months. All cause mortality. coronary heart disease and stroke events were reduced with the use of statins as was the need for revascularisations. Statin treatment reduced blood cholesterol. Taking statins did not increase the risk of adverse effects such as cancer. and few trials reported on costs or quality of life. This current systematic review highlights the shortcomings in the published trials and we recommend that caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk."

Note the last sentence. On the other hand, note that it's about people with /low/ CV risk, and assuming the 30% is not way off the mark, it's probably not what they meant by "low".

Best wishes,

Kevin


-----Original Message-----
From: John Bibby [mailto:[log in to unmask]] 
Sent: 30 January 2012 11:57
To: [log in to unmask]
Subject: Equation predicting 10-year risk of cardiovascular disease (10YRCARD) - where is it?

My friendly GP nurse has told me I have 10YRCARD = 30% i.e. a 30% risk of developing cardiovascular disease over the next 10 years. I have been recommended statins for life, which will bring the 30% down to 23%.

Can anybody point me please to the equations that will have been used to get these figures? (Risk-factors used seem to be age, smoking, alcohol, cholesterol, family history, weight, blood pressure and glucose intolerance.)

Also, can anyone refer me to advice on side-effects of statins (if possible with statistics)?

Thanks

JOHN BIBBY

PS: The above points are practical. The following is pedagogic: Kind friend says "10-year risk of 30% means that you probably won't get anything for 33.333333 years by which time you'll be a dead duck anyhow, so why worry?" Discuss.

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