2016/17 guideline update: questions and answers

Questions and answers on the guideline update for cardiovascular disease risk assessment.

How will the new equations change the way five-year combined cardiovascular event risk is stratified?

Although it is not possible at this stage to provide an accurate distribution of CVD risk, the current stratification will likely remain the same. Those with high absolute risk according to the 2013 update are likely to remain at high relative risk but may have a reduced risk score. Those at low absolute risk will likely remain at low risk. While current equations may have been overestimating risk for some, the recommended treatment thresholds have also been higher than all other international quality assured guidelines.

Will the whole population need to be reassessed?

Current risk assessments are still valid since those at high risk are likely to remain at high risk and current recommended treatment thresholds are also relatively conservative. The combination of our overestimation of risk and higher treatment thresholds are likely comparable with international guidelines.

What were the areas reviewed by the Heart Foundation (available on request)?

The following areas were identified for review, including:

  • expected real world benefit of New Zealand specific risk stratification and risk equations to New Zealanders
  • the CVD risk assessment window / frequency for different risk categories
  • evidence for medication treatment thresholds and goals of treatment
  • lifestyle interventions, including dietary advice that is sustainable for populations with health literacy challenges
  • effective ways to create sustained behaviour change and medication uptake for those at increased risk, including effective risk communication, shared decision making, goal setting
  • co-morbidity with serious mental illness
  • overall consistency with new international guidelines.
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