PROCAM Score For Cardiovascular Risk Calculator

How does this PROCAM score for cardiovascular risk calculator work?

This health tool that stratifies cardiovascular risk takes account of patient parameters and laboratory results. The PROCAM score for cardiovascular risk calculator is based on the Prospective Cardiovascular Münster (PROCAM) cardiovascular epidemiology study and consists of 8 parameters, each with different answer choices and specific weights in the overall result.

■ Age – every 10 decade increase in age after 35 tends to change the risk profile, especially in male patients.

■ History of diabetes – in the family or the patient suffering from diabetes mellitus, increases cardiac event chances.

■ Smoking – history of smoking or current smoking are set to trigger cardiac events.

■ Family history of MI – increased risk when first degree male has suffered from myocardial infarction before the age of 55, or female first degree relative before the age of 65.

■ LDL cholesterol in mg/dL – cholesterol and triglyceride values show a significant age-adjusted association in predicting coronary events.

■ HDL cholesterol in mg/dL – is an important driver of CHD risk and tends to be even of stronger influence when coupled with other cardiovascular risk factors, compared to other parameters in PROCAM.

■ Triglycerides in mg/dL – the lipide profile is part of the CHD risk screening.

■ Systolic blood pressure in mmHg – hypertension is one of the main cardiovascular risk factors.

The method received appraisal because of the fact that it includes relevant parameter information such as family history of coronary heart disease, myocardial infarction and the LDL value, variables often omitted in other cardiac scores.

The original study involved 5,389 men with ages between 35 and 65, followed for 10 years and that have developed a number of 325 coronary events. The order of importance of the risk factors, which act in conjuction, revealed from the study is as follows:

■ Age;

■ LDL cholesterol;

■ Smoking;

■ HDL cholesterol;

■ Systolic blood pressure;

■ Family history of premature myocardial infarction;

■ Diabetes mellitus;

■ Triglycerides.

The scoring system was developed based on beta-coefficients and accurately predicted the subsequent cardiac events.

PROCAM score interpretation

The 8 parameters discussed above comprise of different answer choices, which are then awarded a different number of points, usually from 0 to 6 or 8 or even 20, depending on the severity of the described item.

The overall score ranges from 0 to 87 when all risk factors are being met. The absolute risk of an acute coronary event in the following 10 years after the subject takes the assessment as depicted in this cardiac risk score depends on the presence of individual factors.

The following table depicts the risk stratification based on score:

Compared to the European CVD risk-assessment tool, the SCORE, PROCAM tends to perform better because of being lower in predicting patients at high cardiac risk while SCORE tends to over predict the risk and overestimate the number of patients at risk.

References

1) Assmann G, Cullen P, Schulte H. (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Münster (PROCAM) study. Circulation; 105(3):310-5.

2) Versteylen MO, Joosen IA, Shaw LJ, Narula J, Hofstra L. (2011) Comparison of Framingham, PROCAM, SCORE, and Diamond Forrester to predict coronary atherosclerosis and cardiovascular events. J Nucl Cardiol; 18(5): 904–911.

3) Pater C. (2001) The current status of primary prevention in coronary heart disease. Curr Control Trials Cardiovasc Med; 2(1): 24–37.

4) Assmann G, Schulte H, von Eckardstein A, Huang Y. (1996) High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. The PROCAM experience and pathophysiological implications for reverse cholesterol transport. Atherosclerosis; 124 Suppl:S11-20.