Groups with high risk and not appropriate to risk with cardiovascular risk (CV risk) calculator

• Framingham 1991 risk equations should not be used for people with pre-existing:
  • CHD or angina
  • stroke or transient ischaemic attack
  • peripheral vascular disease
• Framingham risk equation should not be used for people who are already considered at high risk of CVD because of:
  • familial hypercholesterolaemia or other monogenic disorders of lipid metabolism
  • diabetes
    
    
• CVD risk scores may not be appropriate as a way of assessing risk in people who are at increased CVD risk because of underlying medical conditions or treatments. These include people:
  • treated for HIV or with antipsychotic medication
  • people with autoimmune disorders such as systemic lupus erythematosus (SLE) and rheumatoid arthritis
  • people taking medicines that can cause dyslipidaemia such as antipsychotic medication, corticosteroids or immunosuppressant drugs
    
    
• people with CKD (3)
  • offer atorvastatin 20 mg for the primary or secondary prevention of CVD to people with CKD
    • increase thedose if a greater than 40% reduction in non-HDL cholesterol is not achieved and eGFR is 30 ml/min/1.73 m2 or more
    • agree the use of higher doses with a renal specialist if eGFR is less than 30 ml/min/ 1.73 m2

Rheumatoid arthritis and cardiovascular risk:

• data indicate that CVD mortality is increased by approximately 50% in RA patients compared with the general population (2)

Reference:

• (1) NICE (May 2008).Lipid modification - Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
• (2) Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D.Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies Arthritis Rheum. 2008 Dec 15;59(12):1690-7.
• (3) NICE (July 2014). Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease