Mortality statistics of the Turkish Statistical Institute reveal that 408,782 people died in Turkey in 2016. Consistent with global statistics, the most common cause of death in Turkey is cardiovascular diseases (approximately 40 percent, 162,876 people). Approximately 40.5 percent (approximately 65,000) of cardiovascular disease deaths are caused by ischemic heart diseases, while 23.6 percent (approximately 38,000) are caused by cerebrovascular diseases.
Cardiovascular system diseases are the most common cause of death, and should be considered a priority in healthcare risk management. “Healthcare risk management” is a new concept and rapid developments, particularly in genetics, biochemistry and imaging, have shown that health risks can be managed. In societies that keep pace with the latest scientific developments, health problems and related mortality rates decline and the average life expectancy increases. The reason for this is that health is managed better and can be improved before treatment is required. Preventive medicine is rising in value and is the new perception of health, and preventive cardiology is the fastest rising field in preventive medicine.
The idea of assessing heart diseases started long ago and peaked with the research conducted in the small American town of Framingham. Long-term studies conducted on the residents of this small town provided important data to estimate cardiac risk. The cardiac risk score system based on this research is still the basic standard of cardiac risk assessments in the United States. European countries, including Turkey, have formed their own criteria for calculating cardiac risk under the leadership of the European Society of Cardiology (ESC), and have developed treatment models based on the cardiac risk score of individuals.
The basic parameters used in the ESC cardiac risk assessment algorithm (HeartScore2) are age, sex, total cholesterol level, systolic blood pressure, and smoking habits. These criteria are intended to estimate the risk of developing a cardiovascular disease (e.g., death, heart attack or stroke with cardiovascular causes) over the following 10 years. If necessary, the physician may require additional examinations based on the level of risk.
Assess Your Own Risk
The ESC reorganized its cardiac risk assessment algorithm based on the data obtained from Turkey, and published it as ScoreTurkey3 in 2015. The same parameters as those of HeartScore are used. Nevertheless, ScoreTurkey is the first cardiac risk assessment algorithm that uses data from Turkey and is designed specifically for the Turkish population. Therefore, it reflects our true results.
Ali Raif İlaç has turned the cardiac risk assessment algorithm into a mobile application with the Turkish Society of Cardiology (TSC) and shared it with relevant medical branches, primarily cardiologists. Using ScoreTurkey data, the application called KalpRiski can be easily downloaded to any mobile phone and used to estimate of your risk of a cardiovascular event in the next 10 years based on the five parameters mentioned above (age, sex, total cholesterol, systolic blood pressure and smoking).
After you calculate your risk of cardiovascular events for the next 10 years, you can proceed to the ESC LDL-K treatment approach by entering your LDL-K level, which appears as the second phase.
Let’s calculate cardiac risk with an example. Let’s assume that our subject is a male born in 1960 with a systolic blood pressure of 160 mmHg, an overall cholesterol of 280 mg/dl, and who smokes. After entering these five criteria (male, 1960, 160, 280, yes), we press the “calculate risk” button. The result shown is 25 percent. This means that our subject’s risk of having a fatal cardiovascular event (death, heart attack or stroke with cardiovascular causes) in the next 10 years is 25 percent. Depending on the result, the risk is divided into four categories. Zero percent indicates a low risk, 1 to 4 percent indicates a medium risk, 5 to 9 percent indicates a high risk, and 10 percent and above indicates a very high risk. As can be seen, 25 percent in our example means a very high risk.
If you enter 155 in the LDL-K (mg/dl) screen subsequent to the 10-year cardiovascular risk result, the recommended ESC treatment for this patient will appear. The ESC treatment recommendation for our subject patient appears in a red frame as “Lifestyle change and simultaneous medication treatment.”
The purpose of this is to direct a person to take measures against potential heart diseases. It is possible to use the assessment of KalpRiski to ensure that the risks indicated by the application, other than those such as age and sex, are stopped or at least mitigated. In addition to medicines, the lifestyle changes made by an individual play a key role here. For instance, revising our diet, losing weight, integrating physical activities into everyday routine, and avoiding stress as much as possible, helps lower overall cholesterol and systolic blood pressure values, which reduces the risk of cardiovascular diseases.
And we should give up smoking. In addition to damaging many systems, smoking is an important cardiovascular risk factor. The more you smoke, the more you are at risk of cardiovascular diseases in direct proportion to the daily amount and the total duration of smoking.
References:
Turkish Statistical Institution, 2016, https://www.turkiye.gov.tr/turkiye-istatistik-kurumu-baskanligi-tuik
https://heartscore.escardio.org/2007
http://file.tkd.org.tr/kilavuzlar/SCORETurkiye-160125.PDF?menu=52