« Systematic Cerebrovascular and cOronary Risk Evaluation »
This self-playing slide show lasts 2 minutes
SCORE - Canada
Global Cerebrovascular
Risk Assessment
« Systematic Cerebrovascular and cOronary Risk Evaluation »
« Systematic Cerebrovascular and cOronary Risk Evaluation »
SCORE
« Systematic Cerebrovascular and cOronary
Risk Evaluation »
Multiple risk factors usually contribute to the atherosclerosis that
causes cardiovascular disease.
These risk factors interact, sometimes multiplicatively.
Management of the individual components of risk such as
smoking, diet, exercise, blood pressure and lipids impacts on
total cardiovascular risk.
Thus the aim should be to reduce total risk ; if a target cannot
be reached with one risk factor, total risk can still be reduced by
reducing other risk factors.
« Systematic Cerebrovascular and cOronary Risk Evaluation »
The SCORE CANADA message*
For every patient, clinicians should:
1. Assess the risk
2. Set the targets
3. Act to get to goal
* Canadian Vascular Coalition 2004 and C-CHANGE 2011
« Systematic Cerebrovascular and cOronary Risk Evaluation »
The goals are those recommended by the major
Canadian scientific organisations
• Physical Exercise
(Canadian Society of exercise physiology)
• Hypertension
(Canadian Hypertension Education Program)
• Dyslipidemias
(Canadian working group on hypercholesterolemia)
• Diabetes
(Canadian Diabetes Society)
« Systematic Cerebrovascular and cOronary Risk Evaluation »
When should we use the SCORE Canada table?
Use this risk evaluation chart if the patient asks for it
and if during consultation the person is a middle age
smoker or has one or more vascular risk factors or
there is a family history of premature cardiovascular
disease or of major risk factors.
The charts should be used in the light of clinician’s knowledge and
judgement with regard to local conditions.
« Systematic Cerebrovascular and cOronary Risk Evaluation »
SCORE
Canada
10 year Risk of fatal cardiovascular disease
HIGH
≥ 5%
MODERATE
2-4%
LOW
≤ 1%
« Systematic Cerebrovascular and cOronary Risk Evaluation »
SCORE
Canada
10 year Risk of fatal cardiovascular disease
HIGH
≥ 5%
MODERATE
2-4%
LOW
≤ 1%
« Systematic Cerebrovascular and cOronary Risk Evaluation »
How to use the SCORE Canada table ?
1.Find the cell nearest to the person’s gender, age, total/HDL-chol. ratio and
systolic blood pressure values, bearing in mind that the risk will be higher as the
person approaches the next age, cholesterol or blood pressure category.
2.This will give you a percentage representing the risk of dying from
vascular disease in next 10 years.
3.Risk may be higher than indicated in the chart if :
• preclinical atherosclerosis already established ;
• family history of premature cardiovascular disease: X by 1.7 /men and X by 2 in
women
• obesity, BMI > 30 Kg/m2, waist circumference 102 cm or higher in men or 88 cm or
higher in women ;
• sedentarity ;
• diabetes: multiply by 3 in men and by 5 in women ;
• very high triglycerides ;
• high levels of hsC-reactive protein, fibrinogen, homocystein, apoliprotein B or Lp(a).
« Systematic Cerebrovascular and cOronary Risk Evaluation »
SCORE
Canada
10 year Risk of fatal cardiovascular disease
HIGH
≥ 5%
MODERATE
2-4%
LOW
≤ 1%
« Systematic Cerebrovascular and cOronary Risk Evaluation »
When should we use the SCORE Canada table?
Do not use SCORE if
- known cardiovascular disease,
- Pts with diabetes :man> 45 years old ,woman> 50 years old ,presence for
more than 25 years and aged >30 ,CV multi risks ,microvascular disease
- markedly increased single risk factors or
- older than 70 years of age.
The charts should be used in the light of clinician’s knowledge and
judgement with regard to local conditions.
« Systematic Cerebrovascular and cOronary Risk Evaluation »
SCORE
Canada
10 year Risk of fatal cardiovascular disease
HIGH
≥ 5%
MODERATE
2-4%
LOW
≤ 1%
« Systematic Cerebrovascular and cOronary Risk Evaluation »
How to use the SCORE Canada table ?
For younger people less than 40,
Use the “Relative Risk” chart
Use this chart to show younger people, less than 40, at low total risk that,
relative to their age group, their risk may be many times higher than
necessary. This may help to motivate and make decisions about avoidance
of smoking, healthy nutrition and exercise, as well as flagging those who
may become dandidates for pharmalogical treatment.
« Systematic Cerebrovascular and cOronary Risk Evaluation »
How to use the SCORE Canada table ?
Relative Risk chart for people of less than 40
years of age
The number in each cell means that the person is “n” time more at risk
of developing a vascular disease than someone who is at the same age
and where all the other risk factors are minimal.
« Systematic Cerebrovascular and cOronary Risk Evaluation »
What the objectives of vascular prevention?
1. To Assist those at low risk of vascular disease to maintain this state lifelong,
and to help those at higher increased total vascular risk to reduce it.
2. To Obtain the caracteristics of people who tend to stay healthy:
3. To achieve more rigorous risk factor control in high risk subjects, especially
those with established vascular disease, diabetes or kidney disease.
4. To prescribe ASA, statin, ACE-I or ARB in these high risk subjects,
especially those with established atherosclerotic disease.
5. To consider pharmacological treatment to control hypertension and/or
diabetes.
« Systematic Cerebrovascular and cOronary Risk Evaluation »
What the objectives of vascular prevention?
2. To Obtain the caracteristics of people who tend to stay healthy
0 No smoking
5 Five portions of fruit and vegetable or more a day and healthy food
choices
30 Thirty minutes of physical exercise (moderate intensity) a day
140 Blood pressure under 140/90 mmHg
5 Total-cholesterol under 5 mmol/L
3 LDL-cholesterol under 3 mmol/L
0 Zero diabetes ; fasting plasma glucose under 7 mmol/L
0 Zero obesity ; BMI under 25 Kg/m2 and no abdominal obesity
« Systematic Cerebrovascular and cOronary Risk Evaluation »
What the objectives of vascular prevention?
3. To achieve more rigorous risk factor control in high risk
subjects, especially those with established vascular disease,
diabetes or kidney disease.
« Systematic Cerebrovascular and cOronary Risk Evaluation »
What the objectives of vascular prevention?
4. To prescribe ASA, statin, ACEI or ARB in these high
risk subjects, especially those with established
atherosclerotic disease.
5. To consider pharmacological treatment to control
hypertension and/or diabetes.
It is not recommended to use the SCORE tables to monitor risk level when medical
treatment has been initiated
« Systematic Cerebrovascular and cOronary Risk Evaluation »
Public Health Message
0
No smoking
5
portions of fruit and vegetable or more a day
and varied healthy foods, cereals or whole
wheat bread, fish, limit salt (sodium) intake
30
minutes of moderately vigourous exercice on
most days
« Systematic Cerebrovascular and cOronary Risk Evaluation »
Practical Recommendations
Recommendations
0 No smoking
5 portions of fruit and vegetable or more a day and varied healthy foods, cereals or whole wheat bread, fish,
limit salt (sodium) intake
30 minutes of moderately vigourous exercice on most days
Reduce weight if BMI > 25 kg/m2 or waist circumference equal or higher than 88 cm (women), 102 cm
(men)
If SCORE risk is equal or exceeds 5 % or if there is established vascular disease or diabetes with end
organ damage : Prescribe ASA , Statin, ACEI or ARB.
Consider a pharmacological treatment to control hypertension and/or diabetes.
It is not recommended to use the SCORE tables to monitor risk level when medical treatment has been initiated
Lifestyle advice
to maintain low
risk status
Reassess
global risk every
2 years
« Systematic Cerebrovascular and cOronary Risk Evaluation »
SCORE Canada website: www.scorecanada.ca/
« Systematic Cerebrovascular and cOronary Risk Evaluation »