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Angewandte Nuklearmedizin 2024; 47(03): 182-191
DOI: 10.1055/a-2359-0718
Qualitätssicherung in der Nuklearkardiologie
Übersicht

Allgemeine Abschätzung des kardiovaskulären Risikos

General Estimation of Cardiovascular Risk
Stephan Gielen
1   Universitätsklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Klinikum Lippe GmbH, Detmold
,
Irma Bagdoniene
1   Universitätsklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Klinikum Lippe GmbH, Detmold
,
Harm Wienbergen
2   Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Bremen
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Zusammenfassung

Validierte Scores zur Bestimmung des kardiovaskulären Risikos erlauben es, die Individuen zu identifizieren, die von präventiven Interventionen am meisten profitieren. Daneben verdeutlichen sie auf individueller Basis die Folgen ungesunden Lebensstils und die Risikoreduktion durch zielgerichtete Anpassung (z.B. LDL-C-Reduktion). Scores sind damit ein wichtiges Instrument zur Motivation von Patienten, ihr Risikoprofil zu verbessern.

Abstract

The assessment of individual cardiovascular disease risk (CVD) is essential for a cost-effective prevention of cardiovascular morbidity and mortality. While almost half of the population have a very low CVD risk approximately 1/5th of the population have a CVD risk >20% over the next 10 years.

Modern risk scores like the ESC-SCORE2 help to identify those in need of intensified preventive efforts based on basic risk factors like smoking, systolic blood pressure, total cholesterol, age, and sex. According to current ESC-guidelines all men >45 years and all women >55 years should be assessed with SCORE2, which is the best calibrated and validated scoring system for Europe.

The calculation of total cardiovascular risk also permits to calculate an individual heart-age, which makes it easier for the individual patient to understand his own risk profile. Most current risk estimation systems can be accessed online under u-prevent.com/calculators.

Kernaussagen

  • Gerade in Anbetracht des aktuellen demografischen Wandels wird die kardiovaskuläre Prävention immer wichtiger.

  • Moderne Scoring-Instrumente wie der ESC-SCORE2 helfen, frühzeitig Menschen zu identifizieren, die ein hohes Risiko aufweisen, eine kardiovaskuläre Erkrankung zu entwickeln.

  • Nach den aktuellen ESC-Präventionsleitlinien sollten alle Männer ab dem 45. Lebensjahr und alle Frauen ab dem 55. Lebensjahr ein Risiko-Assessment mit einem validierten Score erhalten.

  • Der ESC-SCORE2 ist für die europäischen Länder am besten validiert und kann daher für diesen Zweck uneingeschränkt empfohlen werden.

Schlüsselwörter

Risiko - kardiovaskulär - Gesamtrisiko - Risikoabschätzung - Primärprävention - ESC-SCORE2

Keywords

risk - cardiovascular - total risk - primary prevention - ESC-SCORE2


Publication History

Article published online:
09 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Dalen JE, Alpert JS, Goldberg RJ. et al. The epidemic of the 20(th) century: coronary heart disease. Am J Med 2014; 127: 807-812 DOI: 10.1016/j.amjmed.2014.04.015. (PMID: 24811552)
    CrossrefPubMedGoogle Scholar
  • 2 Mahmood SS, Levy D, Vasan RS. et al. The Framingham Heart Study and the epidemiolo-gy of cardiovascular disease: a historical perspective. Lancet Lond Engl 2014; 383: 999-1008
    CrossrefPubMedGoogle Scholar
  • 3 Meigs JB, D’Agostino RB, Wilson PW. et al. Risk variable clus-tering in the insulin resistance syndrome. The Framingham Offspring Study. Diabetes 1997; 46: 1594-1600
    CrossrefPubMedGoogle Scholar
  • 4 Anderson KM, Wilson PW, Odell PM. et al. An updated coronary risk profile. A state-ment for health professionals. Circulation 1991; 83: 356-362
    CrossrefPubMedGoogle Scholar
  • 5 Wilson PW, D’Agostino RB, Levy D. et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-1847 DOI: 10.1161/01.cir.97.18.1837. (PMID: 9603539)
    CrossrefPubMedGoogle Scholar
  • 6 D’Agostino RB, Vasan RS, Pencina MJ. et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743-753 DOI: 10.1161/CIRCULATIONAHA.107.699579. (PMID: 18212285)
    CrossrefPubMedGoogle Scholar
  • 7 Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J Clin Res Ed 1981; 282: 1847-1851 DOI: 10.1136/bmj.282.6279.1847. (PMID: 6786649)
    CrossrefPubMedGoogle Scholar
  • 8 Manuel DG, Lim J, Tanuseputro P. et al. Revisit-ing Rose: strategies for reducing coronary heart disease. BMJ 2006; 332: 659-662
    CrossrefPubMedGoogle Scholar
  • 9 World Health Organization. Cardiovascular disease prevention and control: translating evi-dence into action. Genf; WHO. 2005 Accessed May 13, 2023 at: https://apps.who.int/iris/bitstream/handle/10665/43235/9241593253_eng.pdf;jsessionid=7FF2AFF9CA9C2F35079C832CD6CBF3E1?sequence=1
    PubMedGoogle Scholar
  • 10 Cooney MT, Dudina A, D’Agostino R. et al. Cardiovascular risk-estimation systems in primary prevention: do they differ? Do they make a difference? Can we see the future?. Circulation 2010; 122: 300-310
    CrossrefPubMedGoogle Scholar
  • 11 Visseren FLJ, Mach F, Smulders YM. et al. 2021 ESC Guidelines on cardio-vascular disease prevention in clinical practice. Eur Heart J 2021; 42: 3227-3337
    CrossrefPubMedGoogle Scholar
  • 12 SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021; 42: 2439-2454
    CrossrefPubMedGoogle Scholar
  • 13 Lloyd-Jones DM, Leip EP, Larson MG. et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 2006; 113: 791-798 DOI: 10.1161/CIRCULATIONAHA.105.548206. (PMID: 16461820)
    CrossrefPubMedGoogle Scholar
  • 14 Reuter S, Reiermann S, Malyar V. et al. A Comparison of Different Algorithms for the Assessment of Cardiovascular Risk in Patients at Waiting List for Kidney Transplantation. PloS One 2016; 11: e0161927 DOI: 10.1371/journal.pone.0161927. (PMID: 27768693)
    CrossrefPubMedGoogle Scholar
  • 15 Artigao-Rodenas LM, Carbayo-Herencia JA, Divisón-Garrote JA. et al. Framingham risk score for prediction of cardiovascular dis-eases: a population-based study from southern Europe. PloS One 2013; 8: e73529
    CrossrefPubMedGoogle Scholar
  • 16 No authors listed. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Eur Heart J 1998;19:1434–1503.
    Google Scholar
  • 17 Pyörälä K, De Backer G, Graham I. et al. Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J 1994; 15: 1300-1331 DOI: 10.1093/oxfordjournals.eurheartj.a060388. (PMID: 7821306)
    CrossrefPubMedGoogle Scholar
  • 18 Conroy RM, Pyörälä K, Fitzgerald AP. et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987-1003 DOI: 10.1016/s0195-668x(03)00114-3. (PMID: 12788299)
    CrossrefPubMedGoogle Scholar
  • 19 D’Agostino RB, Grundy S, Sullivan LM. et al. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001; 286: 180-187 DOI: 10.1001/jama.286.2.180. (PMID: 11448281)
    CrossrefPubMedGoogle Scholar
  • 20 Pyörälä K. Assessment of coronary heart disease risk in populations with different levels of risk. Eur Heart J 2000; 21: 348-350 DOI: 10.1053/euhj.1999.1927. (PMID: 10666347)
    CrossrefPubMedGoogle Scholar
  • 21 Menotti A, Puddu PE, Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J 2000; 21: 365-370 DOI: 10.1053/euhj.1999.1864. (PMID: 10666350)
    CrossrefPubMedGoogle Scholar
  • 22 D’Agostino RB, Russell MW, Huse DM. et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J 2000; 139: 272-281
    CrossrefPubMedGoogle Scholar
  • 23 Assmann G, Cullen P, Schulte H. et al. Response to Conroy et al. SCORE Project. Eur Heart J 2003; 24 (24) 2070-2071 DOI: 10.1016/j.ehj.2003.07.009. (PMID: 14613744)
    CrossrefPubMedGoogle Scholar
  • 24 Piepoli MF, Hoes AW, Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315-2381
    CrossrefPubMedGoogle Scholar
  • 25 Mortensen MB, Tybjærg-Hansen A, Nordestgaard BG. Statin Eligibility for Primary Preven-tion of Cardiovascular Disease According to 2021 European Prevention Guidelines Compared With Other International Guidelines. JAMA Cardiol 2022; 7 (08) 836-843
    CrossrefPubMedGoogle Scholar
  • 26 Gielen S, Wienbergen H, Reibis R. et al. Kommentar zu den neuen Leitlinien (2021) der Europäischen Gesellschaft für Kardiologie (ESC) zur kardiovaskulären Prävention. Kardiologie 2022; 16 (06) 439-454
    CrossrefGoogle Scholar
  • 27 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188 DOI: 10.1093/eurheartj/ehz455. (PMID: 31504418)
    CrossrefPubMedGoogle Scholar
  • 28 Rossello X, Dorresteijn JA, Janssen A. et al. Risk prediction tools in cardiovascular dis-ease prevention: A report from the ESC Prevention of CVD Programme led by the European Association of Preventive Cardiology (EAPC) in collaboration with the Acute Cardiovascular Care Association (ACCA) and the Association of Cardiovascular Nursing and Allied Profes-sions (ACNAP). Eur Heart J Acute Cardiovasc Care 2020; 9: 522-532
    CrossrefPubMedGoogle Scholar
  • 29 Kengne AP. The ADVANCE cardiovascular risk model and current strategies for cardiovascu-lar disease risk evaluation in people with diabetes. Cardiovasc J Afr 2013; 24: 376-381
    CrossrefPubMedGoogle Scholar
  • 30 JBS3 Board. Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart Br Card Soc 2014; 100: ii1-ii67
    Google Scholar
  • 31 Stam-Slob MC, Visseren FLJ, Wouter Jukema J. et al. Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elder-ly patients. Clin Res Cardiol Off J Ger Card Soc 2017; 106: 58-68
    CrossrefPubMedGoogle Scholar
  • 32 Kleipool EE, Dorresteijn JA, Smulders YM. et al. Treatment of hypercholesterolaemia in older adults calls for a patient-centred approach. Heart Br Card Soc 2020; 106: 261-266 DOI: 10.1136/heartjnl-2019-315600. (PMID: 31780523)
    CrossrefPubMedGoogle Scholar
  • 33 Hajifathalian K, Ueda P, Lu Y. et al. A novel risk score to pre-dict cardiovascular disease risk in national populations (Globorisk): a pooled analysis of prospective cohorts and health examination surveys. Lancet Diabetes Endocrinol 2015; 3: 339-355
    CrossrefPubMedGoogle Scholar
  • 34 Gielen S, Koenig W, Landmesser U. et al. Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (Hrsg.). ESC Pocket Guidelines. Prävention von Herz-Kreislauf-Erkrankungen. Version 2021. Grünwald: Bruckmeier. 2022 Accessed May 13, 2023 at: https://leitlinien.dgk.org/2022/pocket-leitlinie-praevention-von-herz-kreislauf-erkrankungen-version-2021/
    PubMedGoogle Scholar
  • 35 Riggs DW, Yeager RA, Bhatnagar A. Defining the Human Envirome: An Omics Approach for Assessing the Environmental Risk of Cardiovascular Disease. Circ Res 2018; 122: 1259-1275 DOI: 10.1161/CIRCRESAHA.117.311230. (PMID: 29700071)
    CrossrefPubMedGoogle Scholar
  • 36 Münzel T, Miller MR, Sørensen M. et al. Reduction of envi-ronmental pollutants for prevention of cardiovascular disease: it’s time to act. Eur Heart J 2020; 41: 3989-3997
    CrossrefPubMedGoogle Scholar
  • 37 Lelieveld J, Münzel T. Air pollution, chronic smoking, and mortality. Eur Heart J 2019; 40: 3204 DOI: 10.1093/eurheartj/ehz439. (PMID: 31230068)
    CrossrefPubMedGoogle Scholar
  • 38 Davies HW, Teschke K, Kennedy SM. et al. Occupational exposure to noise and mortality from acute myocardial infarction. Epidemiol Camb Mass 2005; 16: 25-32
    CrossrefPubMedGoogle Scholar