In 2003, the New Zealand Guidelines Group was updated, creating tables that estimate the 5-year total SSR based on age, gender, ethnic group (Maori or non-Maori), smoking status, lipid levels, glucose and blood pressure (Fig. 45- five). Patients are stratified as having a very high, high, moderate, and low risk. Patients with established CVD, genetic lipid disorders, diabetes, or kidney disease constitute a very high risk group because have a> 20% risk of a follow-up SWS for 5 years. “Aggressive” intervention is recommended for patients with SSR> 15%.
There are small differences between different prognostic scales, they classify patients equally and are an inexpensive initial method of risk assessment. Life-long risk is an important method of risk-reflecting, especially for the young, for whom an early lifestyle change is essential.
Diagnostic tests and new biochemical markers designed for patients with specific complaints can enhance the predictive capabilities of simple scales. Such diagnostic tests are the determination of calcium mass by CRT and the exercise tolerance test (TFN). EchoCG and cardiac catheterization can provide additional prognostic information, but these tests are quite expensive and have potential harmful effects, and their use in prevention remains controversial.
A marker of inflammation CRP may increase the prognostic value of initial screening.
The Women’s Health Study recently showed that adding such simple variables as family history, HbA1C levels in diabetes and CRP, allows almost 50% of women in the intermediate-risk group to qualify for a higher or lower group. This reclassification turned out to be correct in almost all cases, at least according to comparison with the traditional risk criteria ATP III.
Thus, improved risk prediction algorithms should help ensure that preventive treatment, based on both lifestyle changes and drug therapy, is correctly applied in the appropriate group of patients.