Kausik Ray, MBChB, MD, MPhil: Stratifying Cardiovascular Risk in ESC Prevention Guidelines

A review of the newest European Society of Cardiology (ESC) Prevention Guidelines at The Metabolic Institute of America (TMIOA) 2021 Heart in Diabetes sessions in New York, NY this weekend showed European experts’ valuation of tools designed to stratify long-term cardiovascular risk in patients.

Presented by Kausik Ray, MBChB, MD, MPhil, Professor of Public Health and Honorary Consultant Cardiology at Imperial College London, the review highlighted ESC’s implementation of the SCORE2 and SCORE-OP algorithms—the former designed to estimate 10-year risk of cardiovascular disease and the latter designed to estimate older patients’ cardiovascular risk by 4 geographical risk regions in Europe.

The presentation also highlighted the SMART risk tool, designed to provide relative risk for patients nearing thresholds of cardiovascular intervention.

In an interview with HCPLive at the TMIOA meeting, Ray discussed these new tools and their role in better interpreting cardiovascular risk in under-treated populations—namely, women and younger patients.

“For primary prevention, we’ve got healthcare systems by and large that are geared up for treating disease rather than preserving health,” Ray explained. “One of the issues with primary prevention is that the vast majority of events that are going to occur will actually occur in that group, because there’s many more of these in absolute terms.”

As Ray explained, younger patients are generally susceptible to nonfatal cardiovascular events that generally don’t register as surpassing the treatment threshold, and women similarly are treated less for their cardiovascular risks than male counterparts. SCORE2 provides perspective on both fatal and nonfatal events, as well as gender disparities in risk, he said.

“It’s trying to match care to level of risk. You don’t want to overtreat low-risk people,” Ray said. “If we can speak the language of risk, we can speak the language of benefit.”