Chapter 11 CVS risk in the general population

11.1 Assessing risk

Khera et al. (2016): - interaction between genetic risk (from polygenic risk score) and lifestyle with respect to risk of coronary events in over 50,000 subjects. Genetic risk and lifestyle factors independently associate with rates of coronary artery disease. Healthy lifestyle defined as non-smoker, BMI < 30, weekly physical activity and diet rich in fruits, nuts, veg, fish and low in processed foods.

Li et al. (2018): - association of lifestyle factors with life expectancy from age of 50 in USA. Lifestyle factors = not smoking, > 30 mins per day of moderate exercise (including brisk walking), moderate EtOH intake, BMI 19 - 25, healthy diet. Projected gain of 2.5 - 2.8 years per lifestyle factor (additive).

11.2 Interventions to reduce risk

HOPE (2000): - rampiril 10 mg od vs placebo in individuals over 55 with vascular disease or diabetes plus one additional risk factor from HTN, smoking, hypercholesterolaemia, microalbuminuria (but no known HFrEF). (Factorial design also assessing vitamin E.) Rampiril reduced composite end-point (MI, stroke, CVS death) with RR 0.78.