Key result
Using validated CVD risk scores in primary prevention fails to reduce total mortality or risk scores.
Why the study?
Does the use of validated CVD risk scores reduce CVD risk or mortality in adults free from CVD?
Systematic Review (n=31,651)
Yes
Does the use of validated CVD risk scores reduce CVD risk or mortality in adults free from CVD?
Current evidence suggests that while validated CVD risk scores can identify high-risk individuals, the associated interventions in most studies are insufficiently intense to significantly reduce CVD mortality or overall risk scores.
Risk score-selected multifactorial interventions show limited CVD mortality benefit from insufficient intensity; leaves open whether optimized delivery improves outcomes.
OBJECTIVES: The high prevalence of cardiovascular disease (CVD) and the increased cost of treatment have prompted strategies for the primary prevention of CVD in the UK to move towards the use of validated CVD risk scores to identify individuals at the highest risk. There are no reviews evaluating the effectiveness of this strategy as a means of reducing CVD risk or mortality. This review summarizes current evidence for and against the use of validated CVD risk scores for the primary prevention of CVD. DESIGN: We utilized an in depth search strategy to search MEDLINE, EMBASE and the Cochrane database of clinical trials, expert opinions were sought and reference lists of identified studies and relevant reviews were checked. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. SETTING: The majority of included trials were carried out in a primary care setting. 2 trials were carried out in North America, 2 in Scandinavia and 1 in the UK. PARTICIPANTS: 31,651 participants in total were recruited predominantly from a primary care setting. Participants were aged 18-65 years old and were free from CVD at baseline. MAIN OUTCOME MEASURES: Outcome measures used in the included studies were change in validated CVD risk score and CVD/All-cause mortality. RESULTS: We identified 16 papers which matched the inclusion criteria reporting 5 unique trials. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. Only one study reported a significant difference in risk score at follow up and one study reported a significant difference in total mortality, however significant differences in individual risk factors were reported by the majority of identified studies. CONCLUSIONS: This review demonstrates the potential for multifactorial interventions aimed at individuals selected by CVD risk scores for lowering CVD risk and mortality. However, the majority of studies in this area do not provide an intensity of intervention which is sufficient in significantly reducing CVD mortality or validated CVD risk.
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Willis et al. (2012) conducted a systematic review in Cardiovascular disease (n=31,651). Validated CVD risk scores was evaluated on Change in validated CVD risk score and CVD/All-cause mortality. Using validated cardiovascular risk scores for primary prevention across 5 trials (N=31,651) rarely yielded significant reductions in risk scores or total mortality.
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