Heart Age and Cardiovascular Risk

Transcription

1 Heart Age and Cardiovascular Risk Mark Cobain Unilever R+D Colworth Science Park Sharnbrook Bedfordshire Europrevent, Geneva April

2 Conflict of Interest Statement Employment by Unilever PLC A producer of consumer goods (foods, home and personal care products) Funded the development of the Heart Age Tool

3 Differing applications of CVD Risk Scores 1. To identify disease-free individuals at highest risk of incident CVD Requires risk scores should accurately rank order individuals in terms of risk 2. To help in making decisions about treatment options for prevention of CVD (Absolute risk thresholds) Requires risk scores to accurately identify which individuals meet a particular risk threshold 3. To communicate risk and promote understanding Requires output that facilitates alignment of perceived risk with actual risk 4. To motivate risk reduction behaviours Requires output that promotes adherence to medication, lifestyle changes

4 Differing applications of CVD Risk Scores 1. To identify disease-free individuals at highest risk of incident CVD Requires risk scores should accurately rank order individuals in terms of risk 2. To help in making decisions about treatment options for prevention of CVD (Absolute risk thresholds) Requires risk scores to accurately identify which individuals meet a particular risk threshold 3. To communicate risk and promote understanding Requires output that facilitates alignment of perceived risk with actual risk 4. To motivate risk reduction behaviours Requires output that promotes adherence to medication, lifestyle changes

5 % change in FRS from baseline REACH-OUT study 0 Usual care Intervention % P< % FRS= Framingham Risk Score Benner et al., Int J Clin Practice 2008

6 30 year-old female Problems with 10 year risk Overweight Smokes SBP 160mmHg TC 6.2mmol/L HDL-C 1.0mmol/L Potential for False Reassurance Women screened and given low risk category status believed they did not need to change their lifestyle Tjimstra and Bieleman, J Fam Practice year CVD risk 6.5% At 60 years of age the CVD risk would be 29.5% (not accounting for any further increases in risk factors )

7 What is Heart Age? The age at which an individuals estimated % CVD risk would be considered normal Normal risk factors defined by midpoint of normal range Systolic Blood Pressure 125mmHg No hypertensive medication Total cholesterol 180mg/dL HDL cholesterol 45mg/dL (men) Non smoking Non diabetic D Agostino et al., 2008 Circulation

8 Example 30 year-old female Overweight Smokes SBP 160mmHg TC 6.2mmol/L HDL-C 1.0mmol/L % CVD: 6.5% Heart-Age: >45

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10 Heart Forecast Tool (New Zealand) Courtesy of Prof Rod Jackson

11 Heart Age Tool User Process Patient Input CVD Risk Factors Demographic Info Heart Age Calculation High heart age CVD Risk > normal risk for age Low heart age CVD Risk< normal risk for age Tailored Personal Recommendations Diet, physical activity, smoking etc Sign Up for D+L Plan newsletter with guidelines for diet and lifestyle change

12 Heart Age by Age Group and Gender All data to end of December 2010 Mean Heart Age (recalculated) - Age, by age group Average Age = 42 Average Heart Age = 48 54% Female 46% Male Age group All data to end Mean of December Heart Age-Age 2010 Mean Heart Age (recalculated) - Age, by gender and age group Average Agp Gap = 6yrs Age group / Gender Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Mean Heart Age-Age

13 Users who sign up for a plan are less healthy Heart Age Age (yrs) sign up no sign up 2 0 men women

14 (Self Reported) Risk factor profile of those who sign up for a plan Mean Total Cholesterol = 204mg/dL Mean Systolic Blood Pressure = 130mmHg Prevalence of Diabetes = 4.2% Prevalence of Smoking = 28.5%

15 How close is perceived risk to actual risk? Does presentation of risk stimulate health promotion and risk reduction?

16 Risk Perception Trial 413 UK participants recruited online Ages years (mean=45yrs) Participants were smokers or/and obese BMI>29 (mean=30.5) 204 randomly assigned to Heart Age message & 209 to % CVD risk Questionnaire Risk Perception Emotional Response Motivation to Change Lifestyle

17 Measured CVD risk (%) Perceived risk is closer to actual risk after exposure to Heart Age Perceived risk Low Moderate High 'CVD Risk' 'Heart Age' Type of risk presented to user N=413, BMI>30 or smoking Soureti et al., EJCPR (2010)

18 Control 'Heart Age' Intentions Heart Age +Intentions Health Plan Sigm Up Rate (%) Health Plan Sign Up Rates 80 * * P<.01 vs all Experimental Condition Ayres et al., submitted

19 % Awareness of cholesterol increases with age cholesterol known cholesterol not known

20 Validation of Risk Model that uses BMI to replace cholesterol and HDL (D Agostino et al., 2008) Full CVD risk model non lipid CVD risk model Risk category 0 to 5 6 to >20 Total Participants who do not experience an event 0 to 5% 677 (20.1) 179 (5.3) 1 (0) 0 (0) to10% 80 (2.4) 609 (18.1) 179 (5.3) 2 (0.1) to 20% 3 (0.1) 121 (3.6) 652 (19.3) 131 (3.9) 907 >20% 0 (0) 2 (<0.1) 123 (3.7) 615 (18.2) 740 Total Participants who do experience an event 0 to 5% 9 (1.5) 6(1.0) 0 (0) 0 (0) 15 6 to 10% 6 (1.0) 41 (6.9) 16 (2.7) 0 (0) to 20% 1 (0.2) 21 (3.5) 104 (17.5) 26 (4.4) 152 >20% 0(0) 1 (0.2) 39 (6.6) 325 (54.6) 365 Total Net reclassification index score of -8% - meaning overall 8% of men misclassified by non lipid model

21 Validation of Risk Model that uses BMI to replace cholesterol and HDL (D Agostino et al., 2008) Full CVD risk model non lipid CVD risk model Frequency (Row per cent) 0 to 5 6 to >20 Total Participants who do not experience an event 0 to 5% 2088 (50.1) 171 (4.1) 0 (0) 0 (0) to10% 105(2.5) 691 (16.6) 135(3.2) 0 (0) to 20% 1 (<0.1) 107 (2.6) 495 (11.9) 61 (1.5) 664 >20% 1 (<0.1) 0 (0) 73 (1.8) 238 (5.7) 312 Total Participants who do experience an event 0 to 5% 34 (9.6) 7 (2.0) 0 (0) 0 (0) 41 6 to 10% 9 (2.5) 47 (13.2) 13 (3.7) 0 (0) to 20% 0 (0) 18 (5.1) 97 (27.3) 11 (3.1) 126 >20% 0 (0) 0 (0) 18 (5.1) 102 (28.7) 120 Total Net reclassification index score of -6% - meaning overall 6% of women misclassified by non lipid model

22 Using Heart Age as a platform for behaviour change in the community Online Media Screening Events Health Care Professionals Retail Grocery Insurers Hospital Pharmacy

23 World Heart Federation unbranded tool

24 Canada: Activation with Heart and Stroke Foundation digital In store workplace press tv events

25 Private Sector Collaborations

26 30 year-old female False Reassurance Potential? Overweight Poor Diet Inactive/Sedentary Classic Risk Factors normal Family History of Diabetes % CVD: 1% Heart-Age: 30

27 How to bring in the proximal predictor Cardiovascular Disease variables? Clinical risk factors BP Chol/HDL Diabetes Inflammation metabolism Adiposity Metabolic Dysregulation lifestyle Diet Activity Stress Smoking

28 Conclusions Communicating personal CVD risk to patients and the public has the potential to enhance risk reduction behaviours (drugs, lifestyle) Presenting this in the form of a Heart Age enhances the perception of risk in line with actual risk In combination with lifestyle change messages can promote risk reduction behaviour More research is needed to effectively integrate diet and lifestyle measures to avoid false reassurance

29 Colleagues and Collaborators Unilever Colworth, UK Natasha Soureti Bob Hurling Peter Murray Cambridge University, UK Anna Fair Oscar Franco Boston University Ralph D Agostino Sr Ramachandran Vasan Joe Massaro Michael Pencina Auckland University Rod Jackson Susan Wells