THE IMPACT OF THE 2009 CANADIAN LIPID GUIDELINES ON THE CATEGORIZATION OF LOW AND INTERMEDIATE FRAMINGHAM RISK SCORES COMPARED TO 2006
Author Block MF Matangi, DW Armstrong, M Nault, D Brouillard, Kingston, Ontario
BACKGROUND: In the fall of 2009 new Canadian lipid guidelines were published. In comparison to the 2006 guidelines a major change was in the Framingham Risk Score (FRS) calculator. The 2009 FRS calculator now includes all cardiovascular events rather than just coronary events. This will have an impact in the number of patients who could change from low and intermediate FRS to high FRS and who therefore may require lipid lowering treatment. The purpose of our investigation was to retrospectively recalculate the 2009 FRS in patients who by the 2006 FRS calculations were classified as low or intermediate risk.
METHODS AND RESULTS: CARDIOfileTM, our cardiology database was searched for all new consultations (Males ≥ 40yrs and Females ≥ 50yrs) between January 2007 and March 2010 who had their FRS calculated according to the 2006 methodology. Patients who were high risk using the 2006 guidelines (including diabetics) or who were already taking a Statin were excluded. The FRS was then recalculated using the 2009 methodology for the low and intermediate 2006 groups. Both the 2006 and 2009 FRS calculations were adjusted for a FH of premature CAD.
RESULTS: There were 183 patients, 124 were low FRS and 59 intermediate FRS based on the 2006 method. When recalculated using the 2009 method, there were 70 low, 74 intermediate and 39 high FRS. Of the 124 low FRS patients, 38% (n=47) became intermediate and 8% (n=10) became high FRS using the 2009 calculator. Of the 59 intermediate FRS patients, 49% (n=29) became high risk and 5% (n=3) moved down a category to low FRS with the 2009 calculator. Overall when taking at their baseline LDL Cholesterol into consideration, 41% of the 2006 FRS when recalculated need to be placed on lipid lowering treatment.
CONCLUSION: Implementing the FRS calculator in the 2009 Canadian lipid guidelines will lead to treatment of a further 41% of previously categorized low and intermediate patients who did not receive Statin therapy based on the 2006 guidelines. A small number of intermediate patients became low risk with the 2009 FRS calculator but this does not affect treatment. The intermediate FRS patients who became low risk were all young smokers who received higher risk scores with the 2006 FRS calculator.