BMJ 2001;323:75-81 ( 14 July )

Papers

A score for predicting risk of death from cardiovascular disease in adults with raised blood pressure, based on individual patient data from randomised controlled trials

Stuart J Pocock, professor, a Valerie McCormack, research fellow, a François Gueyffier, physician, b Florent Boutitie, statistician, b Robert H Fagard, professor, c Jean-Pierre Boissel, professor, b on behalf of the INDANA project steering committee.

a Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, b Service de Pharmacologie Clinique, Faculté RTH Laennec, BP 8071-69376, Lyon Cedex 08, France, c Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, UZ Gasthuisberg, B-3000 Leuven, Belgium

Correspondence to: S J Pocock stuart.pocock{at}lshtm.ac.uk

Objective: To create a risk score for death from cardiovascular disease that can be easily used.
Design: Data from eight randomised controlled trials of antihypertensive treatment.
Setting: Europe and North America.
Participants: 47 088 men and women from trials that had differing age ranges and differing eligibility criteria for blood pressure.
Main outcome measure: 1639 deaths from cardiovascular causes during a mean 5.2 years of follow up.
Results: Baseline factors were related to risk of death from cardiovascular disease using a multivariate Cox model, adjusting for trial and treatment group (active versus control). A risk score was developed from 11 factors: age, sex, systolic blood pressure, serum total cholesterol concentration, height, serum creatinine concentration, cigarette smoking, diabetes, left ventricular hypertrophy, history of stroke, and history of myocardial infarction. The risk score is an integer, with points added for each factor according to its association with risk. Smoking contributed more in women and in younger age groups. In women total cholesterol concentration mattered less than in men, whereas diabetes had more of an effect. Antihypertensive treatment reduced the score. The five year risk of death from cardiovascular disease for scores of 10, 20, 30, 40, 50, and 60 was 0.1%, 0.3%, 0.8%, 2.3%, 6.1%, and 15.6%, respectively. Age and sex distributions of the score from the two UK trials enabled individual risk assessment to be age and sex specific. Risk prediction models are also presented for fatal coronary heart disease, fatal stroke, and all cause mortality.
Conclusion: The risk score is an objective aid to assessing an individual's risk of cardiovascular disease, including stroke and coronary heart disease. It is useful for physicians when determining an individual's need for antihypertensive treatment and other management strategies for cardiovascular risk.


What is already known on this topic
Many other factors are known to affect the risk of cardiovascular disease in patients with raised blood pressure

A patient's overall risk should be taken into account when determining their need for antihypertensive drugs and other strategies for improving cardiovascular health

What this study adds
A new score uses 11 risk factors to quantify an adult's risk of death from cardiovascular disease, including stroke and coronary heart disease

The score is based on a large cohort of participants in controlled trials of antihypertensive drugs

An individual's risk can be readily assessed as high or low compared with others of the same age and sex

The website www.riskscore.org.uk is available for users of the risk score



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Rapid Responses:

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Timing of smoking
Sunil Bhudia
bmj.com, 15 Jul 2001 [Full text]
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Further comments On Prof. Pocock 's paper and co-workers.
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