Copyright © 2004 by the European Society of Cardiology.
Letter to the editor
Comments on the European guidelines on cardiovascular disease prevention: Reply
University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
E-mail address: guy.debacker{at}ugent.be
The comments made by A. Aessopos and by D. Farmakis on the European guidelines on cardiovascular (CV) disease prevention are well taken. It should be clear that what is published1 is only the executive summary of the guidelines. The full document is now published in the European Journal of Cardiovascular Prevention and Rehabilitation.2
Their comments relate particularly to the use of the SCORE model to estimate total cardiovascular risk in people without known cardiovascular disease (CVD). Reference is made to the response to Conroye et al. SCORE project by Assmann et al;3 these comments were already addressed in another correspondence by Conroy et al.4 In answering the additional remarks made by Aessopos and Farmakis one should keep in mind the purpose of total CV risk estimation: to adapt the intensity of the preventive strategy according to the total CV risk of the subject; the higher the total CV risk the more intense should be the preventive action.
For this purpose, it is essential to ensure that prediction is as accurate as possible and it is not necessary, or desirable, to include all relevant risk factors that may require management in an individual patient.5
The SCORE model has several advantages that are clearly mentioned in the document. One of these is that it is now possible to produce risk charts for individual countries provided reliable mortality information is available. Furthermore, if in a country there is strong and unrefutable evidence from prospective studies that an alternative risk factor can improve the risk prediction over and above what is given in the SCORE charts, then this risk factor can easily be included in the national risk prediction model.
Charts such as provided by SCORE are limited in the number of risk factors that can be included; however the accompanying table with qualifiers should not be separated from the risk charts. Physicians should use the charts in combination with the advices given in the table. The risk charts do not replace good clinical judgment about which risk factors should be managed.
Another issue that could be mistaken is the level of defining "high CV risk" at 
.This is not a magic cutpoint. It should not be interpreted as if <5% means that nothing has to be done and that everything has to be done. At the lower end of the continuum of total CV risk particular emphasis is given to health behaviours and behavioural change. These issues are addressed in more detail in the full document which also elaborates the purpose of total CV risk estimation: to intensify the preventive action with lifestyle modifications and if needed pharmacological treatment in accordance with total CV risk.
References
- Third Joint Task force of European and other Societies on Cardiovascular Disease prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice. Executive summary. Eur. Heart J. 2003;24:1601–10.
- Third Joint Task force of European and other Societies on Cardiovascular Disease prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice. Full text. Eur J. Cardiovascular Prevention and Rehabilitation 2003;10(suppl 1):S1–S78.
- Assmann G, Cullen P, Hense HW et al. Response to Conroy et al. SCORE project. Eur. Heart J. 2003;24:2070.
[Free Full Text] - Conroy RM, Pyorala K, Graham IM. Reply to: response to Conroy et al. SCORE project. Eur. Heart J. 2003;24:2071.
[Free Full Text] - Montgomery AA, Fahey T, Brindle P et al. Coronary risk scores. Lancet. 2004;363:572.[Web of Science][Medline]
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