Refining risk assessment for better prevention

The 75th Irish Cardiac Society Annual Scientific Meeting featured international as well as national expertise. This year’s meeting hosted, among others, Prof André Ng, President of the British Cardiovascular Society. Also in attendance was Ms Cathleen Biga, President of the American College of Cardiology.

Prof Ng spoke about the establishment of virtual wards for acute atrial fibrillation, while Ms Biga delivered a talk on the topic: ‘Cardiology beyond the guidelines: How to improve CV care delivery’.

The meeting also heard from Prof Nathan D Wong, Professor and Director of the Heart Disease Prevention Programme, Division of Cardiology, University of California, US, and Past President of the American Society for Preventive Cardiology. Prof Wong’s talk was titled: ‘Optimising atherosclerotic cardiovascular risk assessment and risk reduction: From concept to practise’.

Prof Wong gave a synopsis of European vs US systems of risk assessment. “We all know that we are too busy cleaning up messes,” Prof Wong told the meeting. “Healthcare costs, especially due to cardiovascular diseases, are unsustainable – over $1 trillion in the US, for example, so the future really needs to be [focused on] prevention.”

In preventive cardiology, the first step is to assess the risk as this is key to determining the intensity of treatment, said Prof Wong. “The intensity of treatment needs to match the person’s risk and we have a variety of risk scores that we can use to start this process.”

Discussing lipid-lowering therapy options, Prof Wong said: “Lp(a) [lipoprotein (a)] is the most important genetic risk factor for cardiovascular disease, yet it is only measured in less than 1 per cent of patients… this can predict a wide range of cardiovascular conditions, such as myocardial infarction, aortic valve stenosis, and even heart failure and atrial fibrillation.”

A social determinant of risk, such as a post code, can help to refine risk estimation, and there is an opportunity to refine risk assessment for people who are borderline or intermediate risk.

“We should always do a complete family history of premature atherosclerotic cardiovascular disease and we should always assess, for example, pregnancy-related conditions in our female patients,” Prof Wong outlined. “Things like pre-eclampsia or gestational diabetes further increase a woman’s risk of cardiovascular disease – even low birth weight infants or premature menopause [increases the risk].”

A patient’s ethnicity – such as African or South Asian – can also inform the need for treatment, he added, as many of these people are often at a higher risk.

Prof Wong briefly discussed newer lipid-lowering agents to reduce the risk of cardiovascular events and emphasised that lifestyle is also a useful risk factor on which to base an estimation.

Lipid-lowering agents have become increasingly important in risk management. He noted that new agents developed to treat obesity and diabetes also play a part in cardiovascular risk prediction, as do inflammation levels.