A score for predicting risk of death from cardiovascular disease in adultswith raised blood pressure, based on individual patient data from randomised controlled trials

Objective To create a risk score for death hum cardiovascular disease that can be easily used. Design Data from eight randomised controlled trials of antihypertensive tre atment. Setting Europe and North America. Participants 47 088 men and women from trials that had differing age ranges and differing eligibility criteria for blood pressure. Main outcome measure 1639 deaths from cardiovascular causes during a mean 5 .2 years of follow up. Results Baseline factors were related to risk of death from cardiovascular disease using a multivariate Cox model, adjusting for trial and treatment g roup (active versus control). A risk score was del eloped from ii factors: age, sex, systolic blood pressure, serum total cholesterol concentration, h eight serum creatinine concentration, cigarette smoking, diabetes, left ven tricular hypertrophy, history of stroke, and history of myocardial infarcti on. The risk score is an integer, with points added fur each factor accordi ng to its association with risk. Smoking contributed more in women and in y ounger age groups. In women total cholesterol concentration mattered less t han in men, whereas diabetes had more of an effect. Antihypertensive treatm ent reduced the score. The five year risk of death front cardiovascular dis ease for scores of 10, 20, 30, 40, 50, and 60 was 0.1%. 0.3%, 0.8'%,, 2.3%, 6.1%, and 15.6%, respectively. Age and sex distributions of the score from the two UK trials enabled individual risk assessment to be age and sex spe cific. Risk prediction models are also presented for fatal coronary heart d isease, fatal stroke, and all cause mortality. Conclusion The risk score is an objective aid tu assessing an individual's risk of cardiovascular disease, including stroke and coronary heart disease . It is useful for physicians when determining an individual's need for ant ihypertensive treatment and other management strategies tur cardiovascular risk.