title: Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study Discussing Coronary Risk with Patients to Improve Blood Pressure Treatment: Secondary Results from the CHECK-UP Study Controlled trial of effect of documented cardiovascular risk scores on prescribing Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) study. Can computerized risk profiles help patients improve their coronary risk? The results of the Coronary Health Assessment Study (CHAS). Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC) Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. The Psychological Impact of Screening for Risk of Coronary Heart Disease in Primary Care Settings Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care [The estimation of cardiovascular risk in hypertensive patients is not modified by management of the hypertension]. Patient knowledge of coronary risk profile improves the effectiveness of dyslipidemia therapy: the CHECK-UP study: a randomized controlled trial. Health checks and coronary risk: further evidence from a randomised controlled trial Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed? Randomized trial of a computerized coronary heart disease risk assessment tool in HIV-infected patients receiving combination antiretroviral therapy. No long-term psychological reaction to information about increased risk of coronary heart disease in general practice Impact of personalized cardiovascular disease risk estimates on physical activity-a randomized controlled trial. Patient-Accessible Tool for Shared Decision Making in Cardiovascular Primary Prevention: Balancing Longevity Benefits Against Medication Disutility
abstract: Objective To derive a new cardiovascular disease risk score ( QRISK ) for the United Kingdom and to vali date its performance against the established Framingham cardiovascular disease algorithm and a newly developed Scottish score ( ASSIGN ) . Design Prospect i ve open cohort study using routinely collected data from general practice . Setting UK practice s contributing to the Q RESEARCH data base . Participants The derivation cohort consisted of 1.28 million patients , aged 35 - 74 years , registered at 318 practice s between 1 January 1995 and 1 April 2007 and who were free of diabetes and existing cardiovascular disease . The validation cohort consisted of 0.61 million patients from 160 practice s. Main outcome measures First recorded diagnosis of cardiovascular disease ( incident diagnosis between 1 January 1995 and 1 April 2007 ) : myocardial infa rct ion , coronary heart disease , stroke , and transient ischaemic attacks . Risk factors were age , sex , smoking status , systolic blood pressure , ratio of total serum cholesterol to high density lipoprotein , body mass index , family history of coronary heart disease in first degree relative aged less than 60 , area measure of deprivation , and existing treatment with antihypertensive agent . Results A cardiovascular disease risk algorithm ( QRISK ) was developed in the derivation cohort . In the validation cohort the observed 10 year risk of a cardiovascular event was 6.60 % ( 95 % confidence interval 6.48 % to 6.72 % ) in women and 9.28 % ( 9.14 % to 9.43 % ) in men . Overall the Framingham algorithm over-predicted cardiovascular disease risk at 10 years by 35 % , ASSIGN by 36 % , and QRISK by 0.4 % . Measures of discrimination tended to be higher for QRISK than for the Framingham algorithm and it was better calibrated to the UK population than either the Framingham or ASSIGN models . Using QRISK 8.5 % of patients aged 35 - 74 are at high risk ( 20 % risk or higher over 10 years ) compared with 13 % when using the Framingham algorithm and 14 % when using ASSIGN . Using QRISK 34 % of women and 73 % of men aged 64 - 75 would be at high risk compared with 24 % and 86 % according to the Framingham algorithm . UK estimates for 2005 based on QRISK give 3.2 million patients aged 35 - 74 at high risk , with the Framingham algorithm predicting 4.7 million and ASSIGN 5.1 million . Overall , 53 668 patients in the validation data set ( 9 % of the total ) would be reclassified from high to low risk or vice versa using QRISK compared with the Framingham algorithm . Conclusion QRISK performed at least as well as the Framingham model for discrimination and was better calibrated to the UK population than either the Framingham model or ASSIGN . QRISK is likely to provide more appropriate risk estimates to help identify high risk patients on the basis of age , sex , and social deprivation . It is therefore likely to be a more equitable tool to inform management decisions and help ensure treatments are directed towards those most likely to benefit . It includes additional variables which improve risk estimates for patients with a positive family history or those on antihypertensive treatment . However , since the validation was performed in a similar population to the population from which the algorithm was derived , it potentially has a “ home advantage . ” Further validation in other population s is therefore required Objectives Hypertension is common among patients with dyslipidemia but is often poorly treated . The objective of this analysis was to evaluate how a decision aid , used by primary care physicians to improve lipid therapy , impacted on the treatment of hypertension . Study Design Data were analyzed from patients enrolled in a r and omized trial focusing primarily on the treatment of dyslipidemia . Patients received usual care or a coronary risk profile every three months to monitor the risk reduction following lifestyle changes and /or pharmacotherapy to treat dyslipidemia . Hypertension management was assessed based on a post hoc analysis of individuals whose blood pressure exceeded current national hypertension guidelines . Results There were 2,631 subjects who completed the study . Among 1,352 patients without diagnosed hypertension , 30 % were above target on at least three consecutive visits . Among 1,279 individuals with known hypertension , 69 % were above target on at least two consecutive visits . Overall , patients receiving risk profiles were more likely to receive appropriate antihypertensive therapy  ( OR = 1.40 , 95 % CI 1.11 – 1.78 ) compared to those receiving usual care . After adjustment for inter-physician variability and potential confounders , the use of the risk profile was associated with an increased likelihood of starting therapy ( OR = 1.78 , 95 % CI 1.06 – 3.00 ) or modifying therapy ( OR = 1.40 , 95 % CI 1.03 – 1.91 ) . Conclusions In this clinical trial of dyslipidemia management , inadequately controlled hypertension was common , occurring in nearly 50 % of individuals . Ongoing coronary risk assessment was associated with more appropriate blood pressure management . Cardiovascular risk assessment decision aids should be further evaluated in a r and omized trial of hypertension therapy Cardiovascular disease causes the death of around 80 % of patients with type 2 diabetes.1 However , risk factors for cardiovascular disease in such patients are often untreated2 despite the proved benefits of intervention . 3 4 One way to help clinicians identify patients at high risk of cardiovascular disease is to use cardiovascular primary prevention risk tables . These tables integrate the multiple risk factors into a single score . We did a pilot study to test the hypothesis that documentation of a  cardiovascular risk score in the case notes would improve the management of cardiovascular risk factors . We recruited patients with type 2 diabetes who had no history of cardiovascular disease or renal disease . All patients were aged 35–75 years and attending a hospital OBJECTIVES Based on the data of the Prospect i ve Cardiovascular Münster ( PROCAM ) study , a prospect i ve study of men and women at work in the north-west of Germany , we aim ed ( i ) to develop a refined scoring scheme for calculating the risk of acute coronary events among adult and elderly men and women ; and ( ii ) to generate a new scoring scheme for calculating the risk of ischaemic stroke or transient ischaemic attack ( TIA ) . METHODS The coronary risk score was derived from a Weibull function using data from 18 460 men and 8515 women who were recruited before 1996 and had a mean follow-up period of 12+/-6 years . The stroke score was derived using a Cox proportional hazards model using data of 5905 men and 2225 women aged 35 - 65 years with at least 10 years of unbroken follow-up . RESULTS The coronary risk score was based on 511 major coronary events , 462 ( 168 fatal , 294 non-fatal ) in men and 49 ( 18 fatal , 31 non-fatal ) in women and included the risk factors LDL cholesterol , HDL cholesterol , systolic blood pressure , smoking status , triglycerides and diabetes mellitus status . It was accurate in both sexes over an age range from 20 to 75 years with an area under the receiver-operating characteristics ( ROC ) curve of 0.82 . The stroke score was based on 85 cerebral ischaemic events ( 21 TIAs , 64 ischaemic strokes ) and included the risk factors age , sex , diabetes mellitus status , smoking status and systolic blood pressure . It had an area under the ROC curve of 0.78 and identified a high-risk group comprising only 4 % of the study population that contained 31 % of all cerebral ischaemic events . CONCLUSION Both new PROCAM risk scores provide simple and effective ways to assess the risk of acute coronary events and ischaemic stroke in the general population and will improve the ability of physicians to target measures in an effort to prevent these potentially devastating conditions BACKGROUND The Coronary Health Assessment Study ( CHAS ) was developed to determine the feasibility of using patient-specific , multifactorial computerized coronary risk profiles as a clinical decision aid to support primary prevention of CHD . METHODS Study participants included 253 community based physicians , r and omized into profile and control groups , and 958 of their patients . The profile group physicians received coronary risk profiles for their patients within 10 working days after the baseline patient assessment providing early feedback . The control group received their profiles only if the patient was clinical ly reevaluated during a 3-month follow-up visit . Patients ' coronary risk factors were evaluated at baseline and at follow-up . RESULTS The profile group had a significantly higher ( P < 0.05 ) ratio of high-risk/low-risk patients who returned for a follow-up visit compared to the control group ( 1.23 vs 0.77 ) . The patients in the profile group also had significantly ( P < 0.05 ) greater mean reductions in total cholesterol ( -0.5 vs -0.1 mmol/L ) , LDL cholesterol ( -0.4 vs 0.0 mmol/L ) , the total cholesterol/ HDL ratio ( -0.6 vs -0.2 ) , and the predicted 8-year coronary risk ( -1.8 vs -0.3 % ) . CONCLUSIONS Computer-generated coronary risk profiles can be effective in assisting physicians to identify high-risk patients . Their use is also associated with significantly greater improvements in the serum lipid profiles and the overall coronary risk of these patients Objective : To improve equity in cardiovascular disease prevention by developing a cardiovascular risk score including social deprivation and family history . Design : The ASSIGN score was derived from cardiovascular outcomes in the Scottish Heart Health Extended Cohort ( SHHEC ) . It was tested against the Framingham cardiovascular risk score in the same data base . Setting : R and om- sample , risk-factor population surveys across Scotl and 1984–87 and North Glasgow 1989 , 1992 and 1995 . Participants : 6540 men and 6757 women aged 30–74 , initially free of cardiovascular disease , ranked for social deprivation by residence postcode using the Scottish Index of Multiple Deprivation ( SIMD ) and followed for cardiovascular mortality and morbidity through 2005 . Results : Classic risk factors , including cigarette dosage , plus deprivation and family history but not obesity , were significant factors in constructing ASSIGN scores for each sex . ASSIGN scores , lower on average , correlated closely with Framingham values for 10-year cardiovascular risk . Discrimination of risk in the SHHEC population was significantly , but marginally , improved overall by ASSIGN . However , the social gradient in cardiovascular event rates was inadequately reflected by the Framingham score , leaving a large social disparity in future victims not identified as high risk . ASSIGN classified more people with social deprivation and positive family history as high risk , anticipated more of their events , and abolished this gradient . Conclusion : Conventional cardiovascular scores fail to target social gradients in disease . By including unattributed risk from deprivation , ASSIGN shifts preventive treatment towards the socially deprived . Family history is valuable not least as an approach to ethnic susceptibility . ASSIGN merits further evaluation for clinical use AIMS To estimate the potential effectiveness of different " high-risk " and " population " approaches to the primary prevention of  cardiovascular disease ( CVD ) in middle-aged British men , after correction for regression dilution bias . METHODS AND RESULTS We used a combination of cohort and r and omised controlled trial evidence to estimate the effectiveness of high-risk strategies , based on the identification of high-risk factors or high absolute risk , and strategies based on population -wide reductions in cholesterol and blood pressure . High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population . Aggressive pharmacological treatment ( using statins , beta-blockers , ACE-inhibitors and aspirin ) in individuals with a 10-year Framingham event risk of > or=30 % ( 6 % of population ) would have reduced major CVD by at most 11 % . This figure increased to 34 % at a > or=20 % treatment threshold ( 26 % of population ) . In contrast , modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD . Taking regression dilution bias into account , 10 % reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45 % . CONCLUSIONS If high-risk strategies are to have a major impact on CVD in the population , they need to be more widely used than previously envisaged . Population -wide reduction of major risk factors is needed if CVD is to be substantially reduced CONTEXT Despite improved underst and ing of atherothrombosis , cardiovascular prediction algorithms for women have largely relied on traditional risk factors . OBJECTIVE To develop and vali date cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factors . DESIGN , SETTING , AND PARTICIPANTS Thirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 10.2 years ( through March 2004 ) for incident cardiovascular events ( an adjudicated composite of myocardial infa rct ion , ischemic stroke , coronary revascularization , and cardiovascular death ) . We used data among a r and om two thirds ( derivation cohort , n = 16 400 ) to develop new risk algorithms that were then tested to compare observed and predicted outcomes in the remaining one third of women ( validation cohort , n = 8158 ) . MAIN OUTCOME MEASURE Minimization of the Bayes Information Criterion was used in the derivation cohort to develop the best-fitting parsimonious prediction models . In the validation cohort , we compared predicted vs actual 10-year cardiovascular event rates when the new algorithms were compared with models based on covariates included in the Adult Treatment Panel III risk score . RESULTS In the derivation cohort , a best-fitting model ( model A ) and a clinical ly simplified model ( model B , the Reynolds Risk Score ) had lower Bayes Information Criterion scores than models based on covariates used in Adult Treatment Panel III . In the validation cohort , all measures of fit , discrimination , and calibration were improved when either model A or B was used . For example , among participants without diabetes with estimated 10-year risks according to the Adult Treatment Panel III of 5 % to less than 10 % ( n = 603 ) or 10 % to less than 20 % ( n = 156 ) , model A reclassified 379 ( 50 % ) into higher- or lower-risk categories that in each instance more accurately matched actual event rates . Similar effects were achieved for clinical ly simplified model B limited to age , systolic blood pressure , hemoglobin A(1c ) if diabetic , smoking , total and high-density lipoprotein cholesterol , high-sensitivity C-reactive protein , and parental history of myocardial infa rct ion before age 60 years . Neither new algorithm provided substantive information about women at very low risk based on the published Adult Treatment Panel III score . CONCLUSION We developed , vali date d , and demonstrated highly improved accuracy of 2 clinical algorithms for global cardiovascular risk prediction that reclassified 40 % to 50 % of women at intermediate risk into higher- or lower-risk categories Aims A prospect i ve study was conducted to identify the psychological impact of labelling middle-aged men as having above average risk for coronary heart disease . A second aim was to find out the psychological effect of participation in a subsequent clinical trial . Methods 5813 men attended nine special screening clinics in Engl and and Scotl and for baseline measurement of psychological symptoms and coronary disease risk factors . Each man was later informed of his risk status by letter as either above average risk ( high-risk ) or no special risk ( low-risk ) . In three clinics some men also received an intermediate risk ( moderate-risk ) between high-risk and low-risk . Follow-up psychological measurements were made after labelling and 3 months later . Results Men who received either the high-risk label ( n = 838 ) or the low-risk label ( n = 3114 ) showed a decrease in reported psychological symptoms after labelling . Men receiving the unexpected intermediate risk ( moderate-risk ) label , which communicated specific test abnormalities , increased their psychological symptoms to ‘ case ’ levels on the General Health Question naire ; relative risk ( compared with low-risk ) was 1.80 ( 95 % confidence interval 1.19 - 2,71 ) after adjustment for confounding factors . Compliers with a subsequent clinical trial decreased their risk of becoming cases and , if ill at trial entry , increased their case remission rate . Conclusions The ascription of an ‘ above average risk ’ label for coronary disease to middle-aged men does not adversely affect the psychological state of those who receive it if they have received preparation for risk labelling . However , communicating abnormal coronary disease test results without adequate preparation confers short-term psychological harm . Non-specific support from familiar general practice professionals received by participants in a clinical trial reduces the risk of psychological ill-health . All coronary disease screening programmes should include adequate pre-labelling preparation for all risk labels and abnormal results BACKGROUND Evidence of the value of systematic ally collecting family history in primary care is limited . OBJECTIVE To evaluate the feasibility of systematic ally collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment . DESIGN Pragmatic , matched-pair , cluster r and omized , controlled trial . ( International St and ardized R and omized Controlled Trial Number Register : IS RCT N 17943542 ) . SETTING 24 family practice s in the United Kingdom . PARTICIPANTS 748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk , seen between July 2007 and March 2009 . INTERVENTION Participants in control practice s had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records . Participants in intervention practice s also completed a question naire to systematic ally collect their family history . All participants were informed of their risk status . Participants with high cardiovascular risk were invited for a consultation . MEASUREMENTS The primary outcome was the proportion of participants with high cardiovascular risk ( 10-year risk ≥ 20 % ) . Other measures included question naire completion rate and anxiety score . RESULTS 98 % of participants completed the family history question naire . The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practice s , compared with 0.3 percentage point in control practice s when family history from patient records was incorporated . The 4.5-percentage point difference between groups ( 95 % CI , 1.7 to 7.2 percentage points ) remained significant after adjustment for participant and practice characteristics ( P = 0.007 ) . Anxiety scores were similar between groups . LIMITATIONS Relatively few participants were from ethnic minority or less-educated groups . The potential to explore behavioral change and clinical outcomes was limited . Many data were missing for anxiety scores . CONCLUSION Systematic ally collecting family history increases the proportion of persons identified as having high cardiovascular risk for further targeted prevention and seems to have little or no effect on anxiety . PRIMARY FUNDING SOURCE Genetics Health Services Research program of the United Kingdom Department of Health OBJECTIVES To compare antihypertensive therapeutic strategies and efficacy whether the physicians were aware or not of the calculated cardiovascular risk at 10 years obtained from the Framingham equation . It was also possible to evaluate the concordance of the general physicians estimation of the cardiovascular risk with the calculated percentage . METHODS The participation of 953 general physicians to the study allowed to achieve an estimation of the absolute cardiovascular risk for 1,243 hypertensives . Patients were r and omised in 2 groups according to the knowledge or not by the physicians of the calculated risk . The therapeutic strategy included a monotherapy ( Fosinopril 20 mg/days ) for a follow up of 8 weeks , with the possibility to increase the treatment after 4 weeks ( Fosinopril + hydrochlorotiazide ) .  To be included , patients had to be more than 18 and less than 75 years , and a blood pressure above 140/90 mmHg . Estimated and calculated cardiovascular risk at 10 years , were classified according to the 1999 WHO-ISH guidelines : low risk < 15 % , medium risk 15 - 20 % , high risk 20 - 30 % , very high risk > 30 % . RESULTS In this population , aged 60 + /- 10 years , with 54 % of men , the concordance between estimated risk and calculated risk was of 35 % . This concordance was better for the " low risk " and " very high risk " , but remains inferior to 50 % . The determinants of concordance were : gender ( male ) , smoking and a low HDL cholesterol . After 8 weeks of treatment , no difference was observed between the 2 groups concerning final blood pressure level , percentage of normalised patients and number of patients with bi-therapy . CONCLUSIONS General physicians estimation of cardiovascular risk at 10 years of hypertensive subjects has a bad concordance with the calculated risk according to Framingham equation . The results of this study indicate that the estimation of cardiovascular risk of hypertensive subjects does not modify the management of hypertension BACKGROUND Despite increasing evidence that treating dyslipidemia reduces cardiovascular events , many patients do not achieve recommended lipid targets . METHODS To determine whether showing physicians and patients the patient 's calculated coronary risk can improve the effectiveness of treating dyslipidemia in a primary care setting , patients were  r and omized  to receive usual care or ongoing feedback regarding their calculated coronary risk and the change in this risk after lifestyle changes , pharmacotherapy , or both to treat dyslipidemia . Outcomes , based on intention-to-treat analysis , included changes in blood lipid levels , coronary risk , and the frequency of reaching lipid targets . RESULTS Two hundred thirty primary care physicians enrolled 3,053 patients . After 12 months of follow-up , 2,687 patients ( 88.0 % ) remained in the study . After adjustment for baseline lipid values , significantly greater mean reductions in low-density lipoprotein cholesterol levels and the total cholesterol to high-density lipoprotein cholesterol ratio were observed in patients receiving risk profiles ( 51.2 mg/dL [ to convert to millimoles per liter , multiply by 0.0259 ] and 1.5 , respectively ) vs usual care ( 48.0 mg/dL and 1.3 , respectively ) , but the differences were small ( -3.3 mg/dL ; 95 % confidence interval [ CI ] , -5.4 to -1.1 mg/dL ; and -0.1 ; 95 % CI , -0.2 to -0.1 , respectively ) . Patients in the risk profile group were also more likely to reach lipid targets ( odds ratio , 1.26 ; 95 % CI , 1.07 to 1.48 ) . A significant dose-response effect was also noted when the impact of the risk profile was stronger in those with worse profiles . CONCLUSIONS Discussing coronary risk with the patient is associated with a small but measurable improvement in the efficacy of lipid therapy . The value of incorporating risk assessment in preventive care should be further evaluated Abstract Objectives : To determine the effectiveness of a health check and assess any particular benefits result ing from feedback of plasma cholesterol concentration or coronary risk score , or both Design : R and omised controlled trial in two Glasgow work sites Subjects:1632 employees ( 89 % male ) aged 20 to 65 years . Interventions : At the larger work site , ( a ) health education ; ( b ) health education and feedback on cholesterol concentration ; ( c ) health education and feedback on risk score ; ( d ) health education with feedback on cholesterol concentration and risk score ( full health check ) ; ( e ) no health intervention ( internal control ) . At the other work site there was no health intervention ( external control ) . Main outcome measures Changes in Dundee risk score , plasma cholesterol concentration , diastolic blood pressure , body mass index , and self reported behaviours ( smoking , exercise , alcohol intake , and diet ) in comparison with internal and external control groups Results : Comparisons between the full health check and the internal control groups showed a small difference ( 0.13 mmol/l ) in the change in mean cholesterol concentration ( 95 % confidence interval 0.02 to 0.22 , P=0.02 ) but no significant differences for changes in Dundee risk score ( P=0.21 ) , diastolic blood pressure ( P=0.71 ) , body mass index ( P=0.16 ) , smoking ( P=1.00 ) , or exercise ( P=0.41 ) . Significant differences between the two groups were detected for changes in self reported consumption of alcohol ( 41 % in group with full health check v 17 % in internal control group , P=0.001 ) , fruit and vegetables ( 24 % v 12 % , P<0.001 ) , and fat ( 30 % v 9 % , P<0.001 ) . Comparison of all groups showed no advantage from feedback of cholesterol concentration or risk score , or both . Conclusions : The health check only had a small effect on reversible coronary risk . It was effective in influencing self reported alcohol consumption and diet . Feedback on cholesterol concentration and on risk score did not provide additional motivation for a change in behaviour Using perceived risk of a heart attack , we examined the relative importance of perceived risk factors and sociodemographic variables on subjects ' perception of heart attack risk , the relationship between perceived and objective ly measured heart attack risk , and the effect of health risk appraisal ( HRA ) feedback on risk perceptions . Data derive from a r and om sample of 732 Greater Boston , Massachusetts area men and women ages 25 - 65 years , who participated in a field trial of health risk appraisal instruments .  At baseline and approximately two months later , all respondents completed a question naire assessing their own health-related behavior , risk factors , and perception of heart attack risk . At baseline , respondents also completed one of four HRA instruments .  Physiologic measures of cholesterol , blood pressure , and weight were taken at either baseline or follow-up visit . Results showed that respondents used established risk factors in estimating overall risk ; that compared to objective measures of risk , a high percentage of respondents displayed an optimistic bias ; and that HRA feedback had some effect on perception of heart attack risk for those at high risk . Implication s of these results for health promotion are discussed BACKGROUND Exposure to combination antiretroviral therapy ( cART ) can lead to important metabolic changes and increased risk of coronary heart disease ( CHD ) . Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients ' risk for CHD . METHODS We conducted a cluster trial within the Swiss HIV Cohort Study ( SHCS ) of HIV-infected patients , aged 18 years or older , not pregnant and receiving cART for > 3 months . We r and omized 165 physicians to either guidelines for CHD risk factor management alone or guidelines plus CHD risk profiles . Risk profiles included the Framingham risk score , CHD drug prescriptions and CHD events based on biannual assessment s , and were continuously up date d by the SHCS data centre and integrated into patient charts by study nurses . Outcome measures were total cholesterol , systolic and diastolic blood pressure and Framingham risk score . RESULTS A total of 3,266 patients ( 80 % of those eligible ) had a final assessment of the primary outcome at least 12 months after the start of the trial . Mean ( 95 % confidence interval ) patient differences where physicians received CHD risk profiles and guidelines , rather than guidelines alone , were total cholesterol -0.02 mmol/l ( -0.09 - 0.06 ) , systolic blood pressure -0.4 mmHg ( -1.6 - 0.8 ) , diastolic blood pressure -0.4 mmHg ( -1.5 - 0.7 ) and Framingham 10-year risk score -0.2 % ( -0.5 - 0.1 ) . CONCLUSIONS Systemic computerized routine provision of CHD risk profiles in addition to guidelines does not significantly improve risk factors for CHD in patients on cART Background R and omised , controlled trials focusing on long-term psychological reactions to information about increased risk of coronary heart disease are scarce . Design A population -based r and omised , controlled , 5-year follow-up trial was conducted in general practice . Methods In 1991 , invitations were sent to 2,000 middle-aged people registered in the general practice s in the district of Ebeltoft , Denmark . A total of 1,507 ( 75.4 % ) agreed to participate and were r and omised into a control group and two intervention groups : one included health screening , a written feedback and an optional follow-up visit with the general practitioner ; the other included health screening , written feedback and a planned 45-min follow-up visit with the general practitioner . The participants were informed at screening about their risk of developing coronary heart disease . Psychological distress was measured by the GHQ-12 before screening and at the 1 and the 5-year follow-up . Results Before the screening ( 0 year ) , 1 and 5 years after there were no significant differences in the GHQ-12 score between the control group and the two intervention groups . Nor were there any differences related to information about increased risk of coronary heart disease between scores obtained at the 1 and the 5-year follow-up . Conclusion Middle-aged persons had no long-term psychological reaction after information about increased risk of developing coronary heart disease following a health screening in general practice evaluated by the GHQ-12,1 year and 5 years after the examinations AIM Informing a person of their individual risk of developing a disease in the future may be sufficient to provide the person with the impetus to adopt risk reducing behaviours . The aim of this study was to determine if a personalised 10-year cardiovascular disease ( CVD ) risk estimate can increase  physical activity  and other risk reduction behaviours in adults at high risk of CVD . METHODS Pilot 2 × 2 factorial r and omised controlled trial conducted in Oxfordshire , UK including 194 adults at increased CVD risk ( 10-year CVD risk ≥ 20 % ) recruited from four general practice s. Main outcome measure at one month was physical activity measured by accelerometer . RESULTS Median ( IQR ) age was 62.3 ( 54.9 , 66.1 ) years , 67 % were men and 19 % had known diabetes . Mean ( SD ) total accelerometer counts per day was 297 × 10(-3 ) ( 110 × 10(-3 ) ) and activity of moderate or greater intensity was undertaken for 53 ( 22 ) minutes per day . In the 185 ( 95 % ) participants attending follow-up an increase in physical activity was not seen . There was a non-significant 0.5 % ( p = 0.56 ) greater increase in accelerometer counts in those receiving personalised CVD risk estimates . No significant within or between group changes were seen at one month in estimated 10-year CVD risk . A net 7 % decrease in mean LDL cholesterol ( p = 0.004 ) was seen in the intervention group despite similar increases in new prescriptions for lipid lowering therapies . CONCLUSION In adults at increased risk of CVD provision of personalised 10-year CVD risk estimates did not appear to increase physical activity or estimated CVD risk over a one-month period Background — Primary prevention guidelines focus on risk , often assuming negligible aversion to medication , yet most patients discontinue primary prevention statins within 3 years . We quantify real-world distribution of medication disutility and separately calculate the average utilities for a range of risk strata . Method and Results — We r and omly sample d 360 members of the general public in London . Medication aversion was quantified as the gain in lifespan required by each individual to offset the inconvenience ( disutility ) of taking an idealized daily preventative tablet . In parallel , we constructed tables of expected gain in lifespan ( utility ) from initiating statin therapy for each age group , sex , and cardiovascular risk profile in the population . This allowed comparison of the widths of the distributions of medication disutility and of group-average expectation of longevity gain . Observed medication disutility ranged from 1 day to > 10 years of life being required by subjects ( median , 6 months ; interquartile range , 1–36 months ) to make daily preventative therapy worthwhile . Average expected longevity benefit  from statins at ages ≥50 years ranges from 3.6 months ( low-risk women ) to 24.3 months ( high-risk men ) . Conclusion — We can no longer assume that medication disutility is almost zero . Over one-quarter of subjects had disutility exceeding the group-average longevity gain  from statins expected even for the highest-risk ( ie , highest-gain ) group . Future primary prevention studies might explore medication disutility in larger population s. Patients may differ more in disutility than in prospect ively definable utility ( which provides only group-average estimates ) . Consultations could be enriched by assessing disutility and exploring its reasons
target: The heterogeneity of the studies limited the analysis , but together they showed that provision of risk information to patients improved the accuracy of risk perception without decreasing quality of life or increasing anxiety , but had little effect on lifestyle .
  There seems evidence that providing CVD risk model estimates to professionals and patients improves perceived CVD risk and medical prescribing , with little evidence of harm on psychological well-being
background: OBJECTIVE To systematic ally review whether the provision of information on cardiovascular disease ( CVD ) risk to healthcare professionals and patients impacts their decision-making , behaviour and ultimately patient health .