Journal of the Practice of Cardiovascular Sciences

LETTER TO EDITOR
Year
: 2016  |  Volume : 2  |  Issue : 2  |  Page : 136-

55/65 rule for India risk prevention


Balram Bhargava1, Raghav Bhargava2,  
1 Department of Cardiology, AIIMS, New Delhi, India
2 Department of Medicine, Glan Clwyd Hospital, Bodelwyddan, Wales, United Kingdom

Correspondence Address:
Balram Bhargava
Department of Cardiology, AIIMS, New Delhi
India




How to cite this article:
Bhargava B, Bhargava R. 55/65 rule for India risk prevention.J Pract Cardiovasc Sci 2016;2:136-136


How to cite this URL:
Bhargava B, Bhargava R. 55/65 rule for India risk prevention. J Pract Cardiovasc Sci [serial online] 2016 [cited 2023 Feb 2 ];2:136-136
Available from: https://www.j-pcs.org/text.asp?2016/2/2/136/191528


Full Text

Dear Editor,

Statins have emerged as “wonder drugs” to treat dyslipidemias and for the prevention of atherosclerotic coronary artery disease (CAD). The role of statin use for secondary prevention is well established; however, there remains a major controversy in the use of these drugs for the primary prevention. Several risk scoring systems have been developed and validated by the Framingham Risk Score,[1] American College of Cardiology,[2] European Society of Cardiology,[3] etc., however the QRisk2 risk scoring calculator is one of the few that has included patients of Asian origin for its validation.[4] The cutoff for treatment with statins for primary prevention varies in different systems. It is recommended that if a 10-year risk of cardiovascular events is more than 7.5–10%, it may be appropriate to initiate statin therapy. Further, it is well established that Indians are more prone to develop CAD and myocardial infarction at a younger age. Indian males are more predisposed to CAD while women lose their protection from CAD as they approach menopause.

The “55/65 Rule” states that an Indian male or female without any traditional risk factor at ages of 55 and 65 years, respectively, have a 10-year risk of approximately 10%. It may, therefore, be appropriate to initiate moderate dose statin therapy in these individuals irrespective of risk scoring. This age further drops to 50 and 60 years in Indian males and females, respectively, if they have any one of the traditional risk factors (diabetes, dyslipidemia, smoking, family history of premature CAD, or hypertension) to initiate statin therapy. The 10-year risk of CAD in these cases (with QRisk2) is more than 7.5–10%.[4] The maximum risk is seen with smoking, family history of premature CAD, diabetes, and hypertension and much less with obesity. A point to remember, when applying this rule, primary prevention with statins, is not so well established after 75 years of age. This may serve as a simple thumb rule for starting statin therapy in Indians.

References

1D'Agostino RB Sr., Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation 2008;117:743-53.
2Muntner P, Colantonio LD, Cushman M, Goff DC Jr., Howard G, Howard VJ, et al. Validation of the atherosclerotic cardiovascular disease pooled cohort risk equations. JAMA 2014;311:1406-15.
3Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: The SCORE project. Eur Heart J 2003;24:987-1003.
4Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, et al. Predicting cardiovascular risk in England and Wales: Prospective derivation and validation of QRISK2. BMJ 2008;336:1475-82.