More about the risk score and its basis

Full details of the risk score and how it was derived was published online in the British Medical Journal on October 10th 2005. The article entitled "Risk score for predicting death, myocardial infarction and stroke in patients with stable angina, based on a large randomised trial cohort of patients" is by Tim Clayton, Jacobus Lubsen, Stuart Pocock, Zoltán Vokó, Bridget-Anne Kirwan, Keith Fox and Philip Poole-Wilson. It can be found here.

The score is derived from data on 7311 patients with stable angina from 19 countries around the world who participated in the ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS) trial. It was published in the Lancet (2004) 364 pp 848-857. Average follow-up was 4.9 years, during which time 495 patients had a myocardial infarction, 170 patients had a stroke and 569 patients died. The distribution of risk scores for these patients is shown in Figure 1.

The selection of risk factors is based on what makes a highly significant independent contribution to predicting risk. Older age, cigarette smoking, being diabetic, previously having a myocardial infarction or stroke all increase a patient's risk. Also linked to increased risk are lower ejection fraction, raised systolic blood pressure, raised white blood cell count, raised blood glucose, raised serum creatinine, and raised QT interval on ECG. The number of anti-anginal drugs a patient is on indicates how severe their angina is, while being on lipid-lowering drugs is linked to lower risk. If the patient has had a coronary angiogram done, having more than three diseased vessels is linked to a higher risk. Lastly, men have a slightly higher risk than women.

Of course, for any patient with angina assessing their risk of death or major cardiovascular events is just an objective starting point. What treatment and life-style strategies to subsequently recommend is beyond the scope of this website and should be primarily led by consultation between the patient and their physician.

Further guidance on the management of angina can be found on the NHS Prodigy website.

By the way, if you wish to assess cardiovascular disease risk in the more general population please do access the following website