Case Finding (Who to Screen)
To Calculator with Decision Support for Mixed Dyslipidemias
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.
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 (1) and the U.S. Preventive
Services Task Force (2) for lipids and ASA respectively. The revised 2009 lipid tables from the
studies are done mainly in
Because the FRS is currently used as a guide to both lipid and ASA recommendations for primary prevention, ASA guidelines are included in this calculator. Decision analysis for ASA is now more complex than simply treating each person with a risk over 10%. The risk of GI hemorrhage must also be taken into account, and this risk is considered in the Preventive Task Force guidelines. The guidelines are firm for men, whose risk is primarily myocardial infarction. They are less firm for women between 55 and 65, whose primary risk is stroke.
Another choice to increase precision in those with 10-19% 10-year risk is the use of hsCRP. In males over age 50 and females over age 60 a hsCRP over 2 has been shown with good evidence to change risk status when LDL is below 3.5 mmol/L. This is also included in the calculator as an option, and the recommendation for this test will be flagged if the patient meets the criteria, and the recommendation would be to treat as high risk with a statin based on the JUPITER trial (7). Patients in the moderate risk category receive a treatment recommendation if LDL if above 3.5 mmol/L. Use of CRP remains optional for this calculator because there is disagreement as to whether outcomes are improved.
diabetics are evaluated similarly to non-diabetics unless a woman is over 50 or
a man over 45. Over these age cutoffs
they are considered high risk (>20%).
Under this age with one additional risk factor they are also considered
high risk. The calculator will flag
these conditions. Emerging or novel risk
factors including the components of metabolic syndrome and selected criteria identified
in the INTERHEART study are built into the optional decision support
calculator. They are helpful in identifying additional relative risk
contributions by metabolic syndrome or multiple factors not evaluated by
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: Strict use of this calculator follows the JUPITER criteria, and will result in statin treatment of up to 62% of adults aged 35-75 (13). While there is evidence for benefit in treatment of patients down to low risk, numbers needed to treat become very high.