Three variants of the updated HeartScore were formally released. These are European models for both high and low risk, and a variant for France, the 15th national version to be developed. The new features include:
• A refinement that allows clinicians the option to enter the actual HDL cholesterol level rather than the combined HDL/LDL cholesterol level—this step improves the accuracy of the model, especially in marginal cases
• A fast track calculator in which BMI replaces blood pressure and cholesterol inputs—this is intended only for when blood pressure and cholesterol are not available and provides only a preliminary assessment
• A risk age function that determines the theoretical age of a person exposed to the same range and level of risk factors—this will help patients quickly understand their exposure to overall cardiovascular disease risk
About 26,000 medical professionals in Europe are already using HeartScore, which has been adapted into 14 national versions to support specific local requirements including language and, when appropriate, to meet mortality rates of individual countries. The application is available online or as a download from the HeartScore Web site at www.heartscore.org. Predictions of cardiovascular disease risk are based on the ESC’s SCORE (Systemic Coronary Risk Evaluation) model, which is itself based on the 2007 ESC Guidelines on cardiovascular disease prevention.
HeartScore conducts a real-time statistical analysis of data entered by the clinician. Results are available immediately and can be archived for future comparisons and progress monitoring.
The model provides a simple graphic display of absolute cardiovascular disease risk together with tailored information on intervention areas, a discussion on the relevant risk factors, and a printed advice pack for the patient that explains the analysis and encourages shifts in behavior and lifestyle when appropriate.
“Our objective is to provide a proven means for predicting cardiovascular disease risk that meets the needs of clinicians and their patients,” said Pantaleo Giannuzzi, MD, President of EACPR. “Because HeartScore is designed to evolve, it can be updated to fit local conditions or reflect fresh thinking. This makes it a powerful tool that offers a great opportunity to highlight the crucial benefits of cardiovascular disease prevention.”
Effective Drugs Underused for Secondary Cardiovascular Disease Prevention
There is great underuse of proven therapies for the secondary prevention of cardiovascular disease, according to results presented from the Prospective Urban Rural Epidemiological (PURE) study.
“The study indicates a large gap in secondary prevention globally,” said Salim Yusuf, MD, lead author and Executive Director of the Population Health Research Institute at McMaster University in Hamilton, Ontario. “We found extremely low rates of use of proven therapies in all countries, but these were more marked in middle- and low-income countries.”
The study, which began recruitment in 2002, included 154,00 adults ages 35 to 70 living in 17 high-, middle-, and low-income countries. All subjects had a history of heart disease or stroke. Among the data collected (at the national, community, and individual levels) were records of subjects’ use of medication along with information about their age, sex, education, and key risk factors such as smoking, diabetes, hypertension, and obesity.
Results showed that even the use of an inexpensive and commonly available treatment such as aspirin varied sevenfold in patients following a heart attack or stroke between low-income and high-income countries; the use of statins varied 20-fold between these countries.
“The data are extremely disturbing,” said Dr. Yusuf, “and indicate a need for systematic efforts to understand why even inexpensive medications are substantially underutilized worldwide. This is a global tragedy and represents a huge, wasted opportunity to help millions of people with heart disease at very low cost.”
There was no clear explanation for the results, which included a lower use of medications among women. Some reasons, the PURE investigators suggested, may be the limited availability of these drugs in low- and middle-income countries, the relatively high cost of even generic versions, side effects, difficulties in transportation, limited access to health care, and a lack of awareness of the need for lifelong therapy among patients and their physicians.
However, the underuse of medication for secondary prevention was not confined to low- and middle-income countries. Even the three high-income countries studied (Canada, Sweden, and the United Arab Emirates) included significant numbers of post-myocardial infarction and stroke patients who were not taking preventive treatment.
The 17 countries included in the PURE study are Canada, Sweden, and United Arab Emirates (high income); Argentina, Brazil, Chile, Malaysia, Poland, South Africa, and Turkey (upper middle income); China, Colombia, and Iran (lower middle income); and Bangladesh, India, Pakistan, and Zimbabwe (low income).