BMJ 1999;318:101-105 ( 9 January )

Information in practice

A simple computer program for guiding management of cardiovascular risk factors and prescribing

Aroon D Hingorani, British Heart Foundation (Gerry Turner) intermediate fellow,  Patrick Vallance, professor of clinical pharmacology and therapeutics. 

Centre for Clinical Pharmacology, Wolfson Institute for Biomedical Research, University College London, London W1P 9LN

Correspondence to: Dr Hingorani a.hingorani{at}ucl.ac.uk

Objective: To describe, and to test against trial data, a simple and flexible computer program for calculating cardiovascular risk in individual patients as an aid to managing risk factors and prescribing drugs to lower cholesterol concentration and blood pressure.
Design: Descriptive comparison of actual cardiovascular risk in randomised controlled trials of cholesterol reduction with risk predicted by a computer program based on the Framingham risk equation. Comparison of the program's performance with that of tables and guidelines by means of hypothetical case examples.
Main outcome measures: Average risk of coronary heart disease and myocardial infarction.
Results: The computer program accurately predicted baseline absolute risk in a UK population as well as the relative and absolute reduction in risk from cholesterol lowering for primary prevention of coronary heart disease. The program also allowed a more refined estimate of absolute risk of coronary heart disease than some existing tables and enabled the impact of prescribing decisions to be quantified and costed.
Conclusions: This simple computer program to estimate individuals' cardiovascular disease risk and display the benefits of intervention should help clinicians and patients decide on the most effective packages of risk reduction and identify those most likely to benefit from modulation of risk factors.

Key messages

  • The absolute risk of coronary heart disease in any individual is determined by a complex interplay of several risk factors

  • We developed a simple computer programme based on data from prospective observational studies to estimate individual risk of cardiovascular disease and predict effects of intervention

  • We compared predicted estimates with actual cardiovascular risk determined from trials of cholesterol reduction

  • The program accurately predicted baseline absolute risk as well as the relative and absolute reduction in risk from cholesterol lowering for primary prevention of coronary heart disease

  • The program should help doctors implement guidelines on the use of statins or antihypertensives by identifying individuals most likely to benefit and should enable patients to make informed decisions about which interventions they would wish to pursue




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