Letter to the Editor
Usefulness of measuring cardiovascular risk at 30 years and vascular age
Utilidad del cálculo del riesgo cardiovascular a 30 años y de la edad vascular
José I. Cuende
Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, Spain
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Cuende" "autores" => array:1 [ 0 => array:3 [ "nombre" => "José I." "apellidos" => "Cuende" "email" => array:1 [ 0 => "jcuendem@telefonica.net" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del cálculo del riesgo cardiovascular a 30 años y de la edad vascular" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The recent publication “Is it useful to calculate cardiovascular risk at the age of 30? (¿Es útil calcular el riesgo cardiovascular a 30 años?)”<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> reviews the concept of cardiovascular risk and analyses whether we are missing the opportunity to treat patients with non-high absolute risk at 10 years. It would be interesting to evaluate risk at the age of 30 in this situation. This condition is frequent in young people whose absolute risk at 10 years is moderate or even low, even though they have several non-controlled risk factors.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This situation is mentioned in several guidelines. In addition, since the European cardiovascular prevention guidelines of 2007,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> the relative risk calculation was proposed as a complementary measure to the absolute risk calculation at 10 years assessed by the SCORE system.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As described by the authors of the publication, we do not know whether relative risk or the risk at 30 years were really able to identify patients who will experience episodes from those who will not. Neither do we know where to place the limit of high risk (when high-risk percentiles<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> are an alternative, according to the authors).</p><p id="par0020" class="elsevierStylePara elsevierViewall">One problem in treating patients with cardiovascular risk factors is how to give them information about their risk condition. According to the authors of the publication, determining risk at the age of 30 places an extra tool at our disposal. Relative risk is also useful for informing and educating, since the concept is easier for the patient to understand. However, there is another concept that is more easily understood by the patient at the time of informing them of their cardiovascular risk: vascular age, which is defined as a person's age with controlled risk factors with the same absolute risk that our patient has in his or her current condition without controlling the risk factors. Vascular age is able to transform the value of absolute risk into a concept that is easier for the patient to understand, and has been given names such as heart age,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> vascular age,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> or risk age.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> This concept of vascular age calculated using SCORE<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> has been taken from the 2012 European guidelines for cardiovascular prevention<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> as a way of communicating risk, in addition to relative risk. It is useful for young people who do not have high absolute risk values but in whom relative risk and vascular age are very high. However, it is not only useful for young people, but also for people of any age because it clearly demonstrates the cardiovascular risk condition of the patient and allows him or her to adopt heart-healthy lifestyle habits or to comply better with prescribed pharmacological treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A clinical trial<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> was recently published with 3 samples, and almost one thousand people in each sample. This trial compared the evolution of various cardiovascular risk factors as a function of the information given to the people taking part. In one sample, the patients were informed neither about absolute risk nor their vascular age. In the second sample, they were informed about their absolute risk and, finally, the third sample was informed about their vascular age. At one-year follow-up, there were significant differences between the 3 samples: people who had been informed about vascular age presented better development since they had made progress on all their risk factors, not just those for which the received pharmacological treatment but also on their non-treated risks.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Vascular age is a new cardiovascular risk measure that allows us to clearly communicate the patients’ risk condition. It is useful not just among young people, and has proved helpful in treating patients with cardiovascular risk factors, according to the European guidelines for cardiovascular prevention. Vascular age tables, using SCORE, allow us to use a single table to inform patients about their absolute risk at 10 years and their vascular age.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,8</span></a> Therefore, they should complement absolute risk in patient treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cuende JI. Utilidad del cálculo del riesgo cardiovascular a 30 años y de la edad vascular. Med Clin (Barc). 2015;144:526–527.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Es útil calcular el riesgo cardiovascular a 30 años?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.J. Hernández Díaz" 1 => "L.M. 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