Open access 1 Johns I, et al. Open Heart 2018;5:e000849. doi:10.1136/openhrt-2018-000849 ► Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ openhrt-2018-000849). To cite: Johns I, Moschonas KE, Medina J, et al. Risk classifcation in primary prevention of CVD according to QRISK2 and JBS3 ‘heart age’, and prevalence of elevated high-sensitivity C reactive protein in the UK cohort of the EURIKA study. Open Heart 2018;5:e000849. doi:10.1136/ openhrt-2018-000849 Received 20 May 2018 Revised 2 August 2018 Accepted 31 August 2018 For numbered affliations see end of article. Correspondence to Professor Julian P Halcox; J.P.J. Halcox@swansea.ac.uk Risk classifcation in primary prevention of CVD according to QRISK2 and JBS3 ‘heart age’, and prevalence of elevated high-sensitivity C reactive protein in the UK cohort of the EURIKA study Ieuan Johns, 1 Konstantinos E Moschonas, 2 Jesús Medina, 3 Nicholas Ossei-Gerning, 4 George Kassianos, 5 Julian P Halcox 6 Cardiac risk factors and prevention © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Key messages What is already known about this subject? ► Novel risk metrics such as JBS3 ‘heart age’ may identify patients with modest conventional cardio- vascular risk scores who are at elevated lifetime risk. ► Patients with elevated levels of high-sensitivity C re- active protein are recognised to be at increased car- diovascular risk, and results of the recent CANTOS trial suggest clinical beneft in treating those with low-grade infammation. What does this study add? ► An additional ~40% of patients in this ‘at risk’ study cohort would be eligible for lipid-lowering therapy following the reduction of the National Institute for Health and Care Excellence treatment threshold from ≥20% to ≥10% 10-year cardiovascular disease (CVD) risk. ► A considerable proportion of those falling below this treatment threshold had an increased JBS3 ‘heart age’ as well as elevated levels of high-sensitivity C reactive protein. How might this impact on clinical practice? ► Measurement of high-sensitivity C reactive pro- tein in addition to the use of lifetime risk metrics may identify a substantial proportion of patients at greater absolute long-term cardiovascular risk than expected on the basis of their conventional 10-year risk scores. These individuals may beneft more from earlier intensive CVD prevention measures. ABSTRACT Objectives This study assessed cardiovascular disease (CVD) risk classifcation according to QRISK2, JBS3 ‘heart age’ and the prevalence of elevated high-sensitivity C reactive protein (hsCRP) in UK primary prevention patients. Method The European Study on Cardiovascular Prevention and Management in Usual Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted in 12 European countries. 673 UK outpatients aged ≥50 years, without clinical CVD but with at least one conventional CVD risk factor, were recruited. 10-year CVD risk was calculated using QRISK2. JBS3 ‘heart age’ and hsCRP level were assessed according to risk category. Results QRISK2 and JBS3 heart age was calculated for 285 of the 305 patients free from diabetes mellitus and not receiving a statin. QRISK2 classifed 28%, 39% and 33% of patients as low (<10%), intermediate (10% to <20%) and high (≥20%) risk, respectively. Two-thirds of low-risk patients and half of intermediate-risk patients had a heart age ≥5 years and ≥10 years higher than their chronological age, respectively. Half of low-risk patients had hsCRP levels ≥2 mg/L and approximately 40% had levels ≥3 mg/L. Approximately 80% of low-risk patients had both elevated hsCRP and heart age relative to their chronological age. Conclusions Almost 40% more patients in this ‘at risk’ group would be eligible for statin therapy following the lowering of the National Institute for Health and Care Excellence treatment threshold to ≥10% 10-year risk. Of patients falling below this treatment threshold, almost all were at increased lifetime risk as measured by JBS3, and of these, the majority had elevated hsCRP levels. These patients with high absolute risk may beneft from early primary CVD prevention. INTRODUCTION Cardiovascular disease (CVD) is a major health concern. It is the leading cause of mortality in Europe and accounts for a third of all deaths in the UK. 1 2 Multiple interacting risk factors contribute to the development of CVD. 3 Well-established risk factors include old age, male sex, smoking, elevated cholesterol levels, hypertension and diabetes mellitus. 3 Cardiovascular risk assessment is routinely performed to assess an individual’s risk of on June 9, 2020 by guest. Protected by copyright. http://openheart.bmj.com/ Open Heart: first published as 10.1136/openhrt-2018-000849 on 17 November 2018. Downloaded from