Calculating and Communicating CVD Risk

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The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
• Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
• Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
• Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

According to Dr. Salgo, good communication skills are essential for physicians because explaining concepts like risk to patients is “part of the art of medicine.”

“It’s good for patients to learn the concept of risk. Because if you think about it, once the person understands that you’re treating risk, then they understand the importance of the medication. If you’re just dealing with numbers, it’s kind of an intellectual gymnastic exercise,” said Dr. Ferdinand.

Because many patients don’t understand the implications of having a 10 percent risk for developing heart attack or stroke, the panelists suggested framing the issue in terms of age (ie, explaining that a patient has the same risk as, say, an 80-year-old man).

Dr. Robinson noted that physicians can find the ASCVD risk calculator online or download it as an app for their smartphone. It can be used to calculate risk for heart attack, stroke, and death. It also includes special equations for African-American patients, which “is really important because of the higher risk in that patient population. And the addition of stroke [calculations] is incredibly important because for African-Americans and white women stroke is a big driver of their cardiovascular events,” she said.