Key result
The SCORE system identified more asymptomatic siblings eligible for risk factor modification than Joint British Guidelines (42.1% vs 7.8% overall; 71.3% vs 16.5% in men, 20.0% vs 1.2% in women).
Why the study?
Does the SCORE system identify a different proportion of asymptomatic siblings of patients with premature CVD as eligible for primary prevention compared to the Joint British Guidelines?
Cross-Sectional (n=589)
Does the SCORE system identify a different proportion of asymptomatic siblings of patients with premature CVD as eligible for primary prevention compared to the Joint British Guidelines?
The SCORE system identifies a substantially higher proportion of asymptomatic siblings of patients with premature CVD as eligible for primary prevention compared to British guidelines.
Answers are grounded in this paper and cite their sources.
SCORE may flag more siblings for intervention than Joint British Guidelines; leaves open whether this improves primary prevention outcomes.
BACKGROUND: Cardiovascular disease (CVD) occurs more frequently in individuals with a family history of premature CVD. Within families the demographics of CVD are poorly described. DESIGN: We examined the risk estimation based on the Systematic Coronary Risk Evaluation (SCORE) system and the Joint British Guidelines (JBG) for older unaffected siblings of patients with premature CVD (onset </=55 years for men and </=60 years for women). METHODS: Between August 1999 and November 2003 laboratory and demographic details were collected on probands with early-onset CVD and their older unaffected siblings. Siblings were screened for clinically overt CVD by a standard questionnaire and 12-lead electrocardiogram (ECG). RESULTS: A total of 790 siblings was identified and full demographic details were available for 645. The following siblings were excluded: 41 with known diabetes mellitus; seven with random plasma glucose of 11.1 mmol/l or greater; and eight with ischaemic ECG. Data were analysed for 589 siblings from 405 families. The mean age was 55.0 years, 43.1% were men and 28.7% were smokers. The mean total serum cholesterol was 5.8 mmol/l and hypertension was present in 49.4%. Using the SCORE system, when projected to age 60 years, 181 men (71.3%) and 67 women (20.0%) would be eligible for risk factor modification. Using JBG with a 10-year risk of 20% or greater, 42 men (16.5%) and four women (1.2%) would be targeted. CONCLUSIONS: Large numbers of these asymptomatic individuals meet both European and British guidelines for the primary prevention of CVD and should be targeted for risk factor modification. The prevalence of individuals defined as eligible for treatment is much higher when using the SCORE system.
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Horan et al. (2007) conducted a cross-sectional in Asymptomatic siblings of patients with early-onset cardiovascular disease (n=589). SCORE system vs. Joint British Guidelines (JBG) was evaluated on Eligibility for risk factor modification. The SCORE system identified more asymptomatic siblings eligible for risk factor modification than Joint British Guidelines (42.1% vs 7.8% overall; 71.3% vs 16.5% in men, 20.0% vs 1.2% in women).
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