Evolution of risk-factor scoring from the 2006 to 2009 CCS guidelines
| RISK FACTOR | SCORING CHANGE | IMPLICATION |
|---|---|---|
| Sex | Women reach high risk at a lower point score (18% vs 23%); unchanged in men | Might reflect inclusion of stroke risk, which is relatively higher in women |
| Age | Age is the main contribution to risk score—increased weighting for both sexes, but more for women | All CVD end points are included; stroke inclusion will increase scores for women |
| Blood pressure (SBP) | SBP has more influence on point score, and the effect is almost double for women | Hypertension is an important contributor to stroke, which affects more women |
| Smoking | Previous tables increased scores for the young and for women; smoking now scores 4 points for men and 3 points for women, with no age differential | Younger smokers will be scored much lower than in previous guidelines |
| Cholesterol | Previously higher point scores for younger age groups and for women; now scored the same across age groups, with women higher at the top lipid levels | Lower scores for younger patients with high lipid levels |
| HDL-C | Scored similarly for both sexes; new tables subtract more points for high HDL-C levels | Increased protection reflected in lower risk scores for those with high HDL-C levels in new tables |
| Family history | CAD in first-degree relative younger than 60 y of age imparts a multiple of 1.7 for women and 2.0 for men; unchanged, but seldom considered in older calculators | More realistic reflection of CAD risk in some patients without other important risk factors |
| hsCRP | Possible reassignment of risk in men older than 50 y and women older than 60 y at moderate risk and with LDL-C < 3.5 mmol/L; those with hsCRP levels > 2.0 mg/L should be treated to high-risk targets according to the new recommendations | Moderate-risk patients with low hsCRP levels are not treated; those with high hsCRP levels or LDL-C levels > 3.5 mmol/L are treated to high-risk targets; reflects some of the findings of the JUPITER study8 |
| Diabetes | Now a recommendation for high-risk status in men older than 45 y and women older than 50 y; younger patients are also scored as high risk if 1 other risk factor is present | Patients with diabetes are treated the same as the general population unless high-risk criteria are present |
CAD—coronary artery disease, CCS—Canadian Cardiovascular Society, CVD—cardiovascular disease, HDL-C–high-density lipoprotein cholesterol, hsCRP—high-sensitivity C-reactive protein, SBP—systolic blood pressure.