Reynolds Risk Score for Cardiovascular Risk in Women

Reynolds Risk Score (Women)

Sex

Age

years

Systolic Blood Pressure

mmHg

hs-CRP

mg/L

Total Cholesterol

mg/dL

HDL Cholesterol

mg/dL

Current Smoker

Parent with MI before age 60

Score:–

–

Estimates 10-year cardiovascular risk in women over age 45 years.

Why Use

May help determine need for statin therapy for risk reduction. Women with a Reynolds Risk score of 10% or less over a ten year period generally do not require statin therapy. Re-classifies 40-50% of women previously in the intermediate cardiovascular range to lower or higher risk categories compared to prior studies, like the Framingham Coronary Heart Disease Risk Score , conducted in mostly Caucasian male patients.

When to Use

Women over age 45.

Formula

10-year cardiovascular disease risk (%) = [1 − 0.98634(exp[B − 22.325])] × 100 where B = 0.0799 × age + 3.137 × ln(systolic blood pressure) + 0.180 × ln(high-sensitivity C-reactive protein) + 1.382 × ln(total cholesterol) −1.172 × ln(high-density lipoprotein cholesterol) + 0.134 × hemoglobin A1c (%) (if diabetic) + 0.818 (if current smoker) + 0.438 (if family history of premature myocardial infarction)

Pearls / Pitfalls

The Reynolds Risk Score estimates risk of adverse cardiovascular event (ischemic stroke, myocardial infarction, need for coronary revascularization, or cardiovascular death) in women over age 45. Derivation study included mostly white women of middle class socioeconomic range, and caution should be used if generalizing to non-white women. The study also did not shed new light on cardiovascular risk in very low risk women (<5% risk over ten years). hsCRP level is not often ordered in routine outpatient laboratory tests.

Advice

Should be used in conjunction with detailed history and physical to aid in identifying female patients who may benefit from statin therapy. Should incorporate clinical judgment when determining a patient's risk for cardiovascular events and benefit of intervention.

More Information

Interpretation: Risk classification Recommendation <5% Unclear evidence for statin therapy 5% to <10% Minimal benefit of statin therapy compared to risk and cost of therapy in preventing a cardiovascular event in the next ten years 10% to <20% Discussion of lifestyle modification and initiation of statin therapy U.S. treatment guidelines recommend initiation of treatment with 10-year risk estimates >10% Understanding patient preference and motivation and frank discussion with patients about the risks and benefits of statin therapy in reducing cardiovascular events such as stroke, MI, and CVA in female patients over the next ten years ≥20% Strongly recommend statin therapy in conjunction with lifestyle modification