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 Thursday, April 17, 2014
 
 
 

PRESIDENT'S MESSAGE


What is the Cardiovascular Risk Calculator?

Debra Kohlman-Trigoboff

In 1942 a medical professor at Yale, C.E. Winslow1 suggested rather than treat a disease process, medicine should change its orientation; start with the disease and work backward to develop the positive ideal of health. This was the beginning of primary prevention. In our every day practices, we often deal with secondary and tertiary prevention, diagnosing and treating existing vascular disease or reducing the negative impact of vascular disease. However, to truly do everything we can for our patients, we should be practicing primary prevention, advocating health promotion to prevent vascular disease altogether.

We know that atherosclerotic cardiovascular disease occurs over decades, and is related to long-term and cumulative exposure to modifiable risk factors. In November 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) published a Cardiovascular (CV) Risk Calculator2 based on research controlled trials. This calculator computes and individual’s 10-year and lifetime risk of atherosclerotic cardiovascular disease (ASCVD), defined as acute coronary syndrome (ACS), history of myocardial infarction (MI), stable or unstable angina, coronary artery disease, vascular disease, history of transient ischemia attack (TIA) or stroke that is vascular in origin. The variables used in the CV Risk calculation are sex, age, race (using two categories of African American or White/Others), total cholesterol, high density lipoprotein, systolic blood pressure, treatment for hypertension, diabetes and smoking.

Using this calculator, a 72 year old African American male who has diabetes, hypertension, smokes, has a Total Cholesterol (TC) of 230, High Density Lipoprotein (HDL) of 32 and systolic blood pressure (SBP) of 160 has a 9.2% 10-year ASCVD risk. An individual whose 10-year risk of ASCVD is greater than 7.5% will need aggressive risk factor management.

The CV Risk Calculator is not intended for patients with known coronary artery disease (CAD), peripheral artery disease (PAD), abdominal aortic aneurysms (AAA) or cerebrovascular disease (CVD) as this population is at high risk (20%) for MI, CAD or death in 10 years. The primary use of the lifetime risk estimates is to facilitate the discussion about risk reduction through lifestyle change. It will also compare the individual’s risk to someone of their age who has optimal risk factor management.

There are several limitations to the calculator. First, the 10-Year risk ASCVD will only work on individuals ages 40-79 and on those ages 20-59 for their Lifetime ASCVD risk. The studies used in the development of this calculator were on populations of African American and White patients; therefore this calculator does not accurately predict risk in non-African American or non-white individuals. Critics of the CV Risk Calculator say that it may under or overcall one’s ASCVD risk. However, it does help open the door to discuss an individual’s risk factors and life-style modifications that they can make.

We now have new evidence-based guidelines from ACC/AHA regarding cholesterol (Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, published in November 20133) and hypertension (2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)4 management which will help guide our patients toward preventative medicine. Below is the link to the CV Risk Calculator. Try it out for yourself, then use it in your practice. Make a difference in preventing vascular disease.

my.americanheart.org/professional/ StatementsGuidelines/PreventionGuidelines/Prevention- Guidelines_UCM_457698_SubHomePage.jsp

References

1 Winslow CE. Preventive Medicine and Health Promotion: Ideals or Realities? Yale J Biol Med.1942 May; 14(5):443–452.

2 Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013.

3 Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, Journal of the American College of Cardiology (2013), doi: 10.1016/j. jacc.2013.11.002.

4 James, PA, Oparil, S, Carter, BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) JAMA. doi:10.1001/jama.2013.284427 published online December 18, 2013.



THE PRESIDENT’S UPDATES...


In this quarter, SVN seeks input from membership and works toward expanding the organization and its member education and benefits.

December 2013

  • Slides from the 2014 convention were posted to SVN website (Free to those who registered for the convention. See website for details)
  • Survey sent to membership to decide whether to change to electronic version of Journal of Vascular Nursing (JVN). Though there was a low response rate, the voting members chose not to change to electronic version of JVN at this time.
  • SVN was asked back to help plan the program for the Cardiovascular Healthcare Professionals conference at VIVA-November 2014

January 2014

  • A new President-Elect, Treasurer and 2 Directors were elected.
  • SVN Images were posted to the website for use in presentations/ publications. (Free to members for SVN use. See website for details)
  • Reaccreditation of PAD/ABI online module was completed
  • Fun Night at convention canceled for this year due to funding
  • Three new Chapters were approved by the Board
  • A new policy was developed for membership discounts for groups The 2014 Convention Program was finalized. This year’s program looks great! Check it out on the website.
  • Several SVN members presented at the 1st Annual Vascular Nursing Boot Camp organized by Tiffany Street at Houston Methodist Hospital, DeBakey Heart and Vascular Center, Houston, Texas.

February 2014

  • Member satisfaction survey was completed. The membership feedback was much appreciated by the Board and will be discussed on the March BOD Conference Call.
  • Society Promotion and Member Recognition committee has created two Clinical Excellence Awards for 2015-one for the Advanced Practice Nurse, the other for the non-Advanced Practice Nurse
  • The 2014 Cardiometabolic Health Congress approached SVN to partner the Journal for Vascular Nursing (JVN) with the Journal of Nutrition Education. Proposal reviewed by Cindy Lewis, JVN editor and BOD and felt not to be of benefit to SVN members.
  • We continue to work on finalizing the program for the Vascular Nursing Convention in South Africa-October 2014
  • AAAneurysm will offer AAA screening of the public and will provide a speaker series during the convention in San Antonio, TX this May.