Case Finding (Who to Screen)
This is not a Palm application.† It will run from the web, or it can be downloaded to your own computer and run from there as a web page.
∑ Inputs include standard FRS risk factors, but include family history
∑ Interventions can be input to evaluate impact on the FRS and determine absolute risk reduction and numbers needed to treat
∑ Interventions include exercise (high and moderate intensity), Mediterranean diet and statins (high and moderate intensity)
∑ Risk and intervention parameters are tracked and graphed continuously to enhance patient understanding of impact of lifestyle and medications
∑ Cardiovascular age is calculated to enhance patient understanding
∑ Interventions are generated according to 2016 Canadian Cardiovascular Society (CCS) and 2015 Simplified Lipid Guidelines
∑ Changes can be made to risk factors or interventions without resetting the calculator
∑ Results and graphics can be printed
∑ See instructions for more information
This calculator focuses on primary prevention of† cardiovascular events in people without known heart disease.† Derivation tables come from guidelines recently published by the Canadian Cardiovascular Society  and the College of Family Physicians of Canada  for lipids.† ASA recommendations are taken from supplementary material supplied with the second reference.† CCS guidelines retain some of the treatment thresholds and targets which are not well established in evidence, and the Simplified Lipid Guidelines recommendations are included in this calculator to allow for an alternative risk-based approach.† Guidelines are largely based on randomized controlled studies, however family history recommendations are of necessity based on cohort studies, and interpretation of the literature with respect to diabetics is still somewhat mixed.† ASA benefits are small in primary prevention, and therapy should be decided on a case by case basis.†
studies are done mainly in
The mixed and atherogenic dyslipidemias, flagged most often by high triglycerides and low HDL, are not addressed by these guidelines.† This is in part because the evidence base for management is less firm.† Emerging or novel risk factors including the components of metabolic syndrome and selected criteria identified in the INTERHEART study  are built into an optional decision support calculator. They are helpful in identifying additional relative risk contributions by metabolic syndrome or multiple factors not evaluated by Framingham, and can be predictive in younger people who may be at high long term risk because of multiple low-grade risk factors.† Metabolic syndrome and novel risk factors will be flagged if you choose decision support, and additional calculation of Total Cholesterol/HDL ratio and non-HDL cholesterol is available to help identify patients with these atherogenic (or mixed) dyslipidemias.
analysis for primary prevention has become more evidence-based and
complex.† Use of tables is still
possible, but it is prone to error and consumes a great deal of time.† For decisions which have to be made several
times a day by primary care providers, a more efficient means of calculation is
necessary.† Existing older calculators
tend to underestimate risk substantially.†
Many of them are developed using
Caveat:† Intervention recommendations are made with the understanding that the patient has been adequately informed and consulted.† Tools such as risk reduction calculation, graphing of results and estimated cardiac age may help with this decision.† Generation of numbers needed to treat (NNT) may help the physician to further frame a decision, although this figure will be less reliable for lifestyle interventions, which are mainly based on cohort studies.