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    Reynolds Risk Score for Cardiovascular Risk in Women

    Estimates 10-year cardiovascular risk in women over age 45 years.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Women over age 45.

    • The Reynolds Risk Score estimates risk of adverse cardiovascular event (ischemic stroke, myocardial infarction, need for coronary revascularization, or cardiovascular death) in women over age 45.
    • Derivation study included mostly white women of middle class socioeconomic range, and caution should be used if generalizing to non-white women.
    • The study also did not shed new light on cardiovascular risk in very low risk women (<5% risk over ten years).
    • hsCRP level is not often ordered in routine outpatient laboratory tests.
    • May help determine need for statin therapy for risk reduction. Women with a Reynolds Risk score of 10% or less over a ten year period generally do not require statin therapy.
    • Re-classifies 40-50% of women previously in the intermediate cardiovascular range to lower or higher risk categories compared to prior studies, like the Framingham Coronary Heart Disease Risk Score, conducted in mostly Caucasian male patients.
    years
    mm Hg
    mg/dL
    mg/dL
    mg/L
    About the Creator
    Dr. Paul Ridker
    Content Contributors
    • Emma Oberlander, DO
    • Jessica Bloom-Foster, MD

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Should be used in conjunction with detailed history and physical to aid in identifying female patients who may benefit from statin therapy.
    • Should incorporate clinical judgment when determining a patient's risk for cardiovascular events and benefit of intervention.

    Management

     

    Risk classification

    Recommendation

    <5%

    Unclear evidence for statin therapy.

    5% to <10%

    Minimal benefit of statin therapy compared to risk and cost of therapy in preventing a cardiovascular event in the next ten years.

    10% to <20%

    • Discussion of lifestyle modification and initiation of statin therapy.
    • U.S. treatment guidelines recommend initiation of treatment with 10-year risk estimates >10%.
    • Understanding patient preference and motivation and frank discussion with patients about the risks and benefits of statin therapy in reducing cardiovascular events such as stroke, MI, and CVA in female patients over the next ten years.

    >20%

    Strongly recommend statin therapy in conjunction with lifestyle modification.

    Formula

    10-year cardiovascular disease risk (%) = [1 − 0.98634(exp[B − 22.325])] × 100%

    where

    B = 0.0799 × age + 3.137 × natural logarithm (systolic blood pressure) + 0.180 × natural logarithm (high-sensitivity C-reactive protein) + 1.382 × natural logarithm (total cholesterol) −1.172 × natural logarithm (high-density lipoprotein cholesterol) + 0.134 × hemoglobin A1c (%) (if diabetic) + 0.818 (if current smoker) + 0.438 (if family history of premature myocardial infarction)

    Evidence Appraisal

    The Reynolds Risk Score was developed by Ridker et al in 2007. They assessed 35 factors in 24,558 initially healthy women, age 45 and older. Participants were followed for an average of 10.2 years and evaluated for cardiovascular events (MI, ischemic stroke, coronary revascularization, and cardiovascular death).

    Study participants were divided into thirds. Two-thirds (n=16,400) were randomly assigned to a model (A or B) derivation set. The remaining third (n=8,158) were assigned to an independent validation set.

    A best overall prediction algorithm (model A) was fit from the data using Cox proportional hazards. 43% of all participants assigned to model A, who had a risk score between 5% and <20% based on Adult Treatment Panel III (ATP III) Guidelines, were reclassified to a lower or higher risk score that more closely matched actual cardiovascular events. 50% of women assigned to model A who did not have diabetes, with a 10-year risk between 5% and <20% based on ATP III, were similarly reclassified to a lower or higher risk score.

    Model A was clinically simplified to create the Reynolds Risk score (Model B), which showed similar reclassification of 30%-45% (compared to Model A, 43%-50%) of intermediate risk women to higher and lower risk scores.

    Neither model found significant evidence for reclassification of women at ATP III 10-year very low risk <5%.

    Dr. Paul Ridker

    About the Creator

    Paul M. Ridker, MD, MPH is the Eugene Braunwald Professor of Medicine at Harvard Medical School and directs the Center for Cardiovascular Disease Prevention, a translational research unit at the Brigham and Women’s Hospital in Boston. Dr. Ridker’s research focuses on the design and conduct of multi-national randomized trials, the development of inflammatory biomarkers for clinical and research use, the molecular and genetic epidemiology of cardiovascular diseases, and novel strategies for cardiovascular disease detection and prevention. He is a practicing cardiologist at the Brigham and Women’s Hospital in Boston and an echocardiographer by sub-specialty training.

    To view Dr. Paul Ridker's publications, visit PubMed

    Content Contributors
    • Emma Oberlander, DO
    • Jessica Bloom-Foster, MD