Jon,
We develop a risk stratification tool within the LIPID trial cohort (9,014
randomised patients, all post-MI).
Much the same risk factors as pre-event/pre-treatment.
Reference below.
Paul Glasziou
J Am Coll Cardiol. 2001 Jul;38(1):56-63.
Long-term risk stratification for survivors of acute coronary syndromes.
Results from the Long-term Intervention with Pravastatin in Ischemic
Disease (LIPID) Study. LIPID Study Investigators.
Marschner IC, Colquhoun D, Simes RJ, Glasziou P, Harris P, Singh BB,
Friedlander D, White H, Thompson P, Tonkin A; Long-Term Intervention with
Pravastatin in Ischemic Disease (LIPID) Study.
NHMRC Clinical Trials Center, University of Sydney, Australia.
[log in to unmask]
OBJECTIVES: We developed a prognostic strategy for quantifying the
long-term risk of coronary heart disease (CHD) events in survivors of acute
coronary syndromes (ACS). BACKGROUND: Strategies for quantifying long-term
risk of CHD events have generally been confined to primary prevention
settings. The Long-term Intervention with Pravastatin in Ischemic Disease
(LIPID) study, which demonstrated that pravastatin reduces CHD events in
ACS survivors with a broad range of cholesterol levels, enabled assessment
of long-term prognosis in a secondary prevention setting. METHODS: Based on
outcomes in 8,557 patients in the LIPID study, a multivariate risk factor
model was developed for prediction of CHD death or nonfatal myocardial
infarction. Prognostic indexes were developed based on the model, and low-,
medium-, high- and very high-risk groups were defined by categorizing the
prognostic indexes. RESULTS: In addition to pravastatin treatment, the
independently significant risk factors included: total and high density
lipoprotein cholesterol, age, gender, smoking status, qualifying ACS, prior
coronary revascularization, diabetes mellitus, hypertension and prior
stroke. Pravastatin reduced coronary event rates in each risk level, and
the relative risk reduction did not vary significantly between risk levels.
The predicted five-year coronary event rates ranged from 5% to 19% for
those assigned pravastatin and from 6.4% to 23.6% for those assigned
placebo. CONCLUSIONS: Long-term prognosis of ACS survivors varied
substantially according to conventional risk factor profile. Pravastatin
reduced coronary risk within all risk levels; however, absolute risk
remained high in treated patients with unfavorable profiles. Our risk
stratification strategy enables identification of ACS survivors who remain
at very high risk despite statin therapy.
At 07/03/2005, Jon Brassey wrote:
>Hi!
>
>My understanding is that the CHD risk assessment tools e.g. Framingham are
>only valid for pre-treatment risk assessment. Does anyone know of any
>that are valid for use once treatment has started?
>
>Cheers
>
>jon
>
>Jon Brassey
>NLH Q&A Service
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Paul Glasziou
Department of Primary Health Care &
Director, Centre for Evidence-Based Practice, Oxford
ph: 44-1865-227055 www.cebm.net
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