Introduction

• Cardiovascular disease (CVD) is the leading cause of death globally, necessitating early identification and intervention.
• Cardiac risk calculators estimate an individual’s risk of developing CVD, empowering proactive prevention strategies such as lifestyle changes and medication.

What is a Cardiac Risk Calculator?

• A screening tool that evaluates the likelihood of future cardiovascular events based on individual risk factors.
• Primarily for individuals without a prior heart attack, stroke, or heart failure.

Types of Cardiac Risk Calculators

1. ASCVD Risk Calculator
   • Developed by the American College of Cardiology (ACC) and American Heart Association (AHA).
   • Estimates 10-year and lifetime risks of heart disease.
2. Reynolds Risk Score
   • For individuals without diabetes.
   • Includes risk factors like age, sex, blood pressure, cholesterol, family history, and high-sensitivity C-reactive protein (hsCRP) levels.

Information Required for Cardiac Risk Assessment

• Demographics: Age, sex, and race.
• Medical History: Family history of premature heart disease (before age 60).
• Lifestyle Factors: Smoking status.
• Current Health Data:
  • Blood pressure.
  • Cholesterol levels.
  • Diabetes status.
  • Use of medications like statins, aspirin, or blood pressure medications.

Interpreting Cardiac Risk Scores

• Calculators provide a percentage risk for developing CVD:
  • Low risk: < 5%.
  • Borderline risk: 5%–7.4%.
  • Intermediate risk: 7.5%–19.9%.
  • High risk: ≥ 20%.

Additional Tests for Comprehensive Risk Assessment

• hsCRP Blood Test: Detects inflammation.
• Lipid Panel: Evaluates cholesterol, including lipoprotein(a).
• Electrocardiogram (ECG): Monitors heart’s electrical activity.
• Exercise Stress Test: Assesses heart function during exertion.

Improving Heart Disease Risk Score

1. Lifestyle Modifications:

   • Heart-Healthy Diet:
     • Limit: Saturated fats, trans fats, sodium, sugar, and red meat.
     • Increase: Fruits, vegetables, whole grains, lean protein (poultry, fish), and nuts.
   • Exercise: At least 150 minutes/week of moderate aerobic activity.
   • Weight Management: Achieve and maintain a healthy weight.
   • Stress Management: Adopt techniques like mindfulness and relaxation exercises.
   • Smoking Cessation: Stop smoking and avoid secondhand smoke.

2. Medication Management:

   • Control conditions like hypertension, diabetes, and hypercholesterolemia through:
     • Adherence to prescribed medications (e.g., statins, blood pressure meds).
     • Regular monitoring and adjustments as needed.

The Role of Pharmacists in Cardiovascular Risk Management

Pharmacists are accessible healthcare professionals who play a significant role in risk reduction:

1. Patient Education:

   • Provide information on CVD risk factors and importance of assessment.
   • Explain strategies for lifestyle and medication adherence.

2. Medication Counselling:

   • Ensure understanding of prescribed medications, including statins and aspirin.
   • Address concerns about side effects and drug interactions.

3. Lifestyle Support:

   • Encourage adoption of a heart-healthy diet and regular exercise.
   • Support smoking cessation efforts.

4. Collaboration with Healthcare Teams:

   • Share insights with physicians and other healthcare providers.
   • Assist in optimising treatment plans based on risk scores and patient needs.

Conclusion

• Cardiovascular risk calculators are essential tools for assessing and preventing CVD.
• Pharmacists contribute by:
  • Educating patients.
  • Managing medications.
  • Supporting lifestyle modifications.
• Active engagement in cardiovascular risk management improves outcomes and reduces the burden of CVD.

References

1. Cleveland Clinic. Heart Risk Factor Calculators.
2. Lam, C. S., & Pang, S. Y. Advances in cardiovascular risk prediction: The role of risk factor calculators.
3. American College of Cardiology. Clinician Guide to the ABCs of Cardiovascular Risk Management.