Coronary and cardiovascular risk estimation for primary prevention: validation of a new Sheffield table in the 1995 Scottish health survey population

doi:10.1136/bmj.320.7236.671

BMJ 2000;320:671-676 ( 11 March )

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Coronary and cardiovascular risk estimation for primary prevention: validation of a new Sheffield table in the 1995 Scottish health survey population

Editorial by Jackson

Erica J Wallis, research assistant, Lawrence E Ramsay, professor, Iftikhar Ul Haq, research fellow, Parviz Ghahramani, research associate, Peter R Jackson, reader, Karen Rowland-Yeo, non-clinical lecturer, Wilfred W Yeo, senior lecturer.

Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Sheffield S10 2JF

Correspondence to: L E Ramsay d.colley{at}sheffield.ac.uk

Objective: To examine the accuracy of a new version ofthe Sheffield table designed to aid decisions on lipids screeningand detect thresholds for risk of coronary heart disease neededto implement current guidelines for primary prevention of cardiovasculardisease.
Design: Comparison of decisions made on the basisof the table with absolute risk of coronary heart disease or cardiovasculardisease calculated by the Framingham risk function. The decisionsrelated to statin treatment when coronary risk is $>=$ 30% over 10years; aspirin treatment when the risk is $>=$ 15% over 10 years;and the treatment of mild hypertension when the cardiovascularrisk is $>=$ 20% over 10years.
Setting: The table is designed for use in generalpractice.
Subjects: Random sample of 1000 people aged 35-64 yearsfrom the 1995 Scottish healthsurvey.
Main outcome measures: Sensitivity, specificity, and positive andnegative predictive values of thetable.
Results: 13% of people had a coronary risk of $>=$ 15%,and 2.2% a risk of $>=$ 30%, over 10 years. 22% had mild hypertension(systolic blood pressure 140-159 mm Hg). The table indicated lipidsscreening for everyone with a coronary risk of $>=$ 15% over 10 years,for 95% of people with a ratio of total cholesterol to high densitylipoprotein cholesterol of $>=$ 8.0, but for <50% with a coronaryrisk of <5% over 10 years. Sensitivity and specificity were 97%and 95% respectively for a coronary risk of $>=$ 15% over 10 years;82% and 99% for a coronary risk of $>=$ 30% over 10 years; and 88%and 90% for a cardiovascular risk of $>=$ 20% over 10 years in mildhypertension.
Conclusion: The table identifies all high risk peoplefor lipids screening, reduces screening of low risk people bymore than half, and ensures that treatments are prescribed appropriatelyto those at high risk, while avoiding inappropriate treatmentof people at lowrisk.

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