Risk prediction model
|
Framingham Risk Score
|
10-year risk of developing CVD, not referring to a specific risk model
|
Framingham Risk Score
|
Framingham Risk Score
|
Outcome of interest and its timeframe
|
CHD (10 years)
|
CVD (CHD and stroke, 10 years)
|
CHD (10 years)
|
CHD (10 years)
|
Information on validation of the model provided in the guideline
|
Yes
|
Unclear
|
Yes
|
Yes
|
Evidence of treatment effects
|
Treatment considered
|
LDL-lowering therapy, therapeutic lifestyle change and LDL goals
|
Statin
|
Diet, weight management, physical activity, drug therapy and LDL-C goals
|
Lifestyle management, pharmacotherapy and LDL-C target levels
|
Target population
|
Adults
|
Adults at risk of CVD
|
Adult patients at increased risk of stroke
|
Adult women 20 years and older
|
Type of studies considered in the evidence of treatment benefits
|
Single or several RCTs
Meta-analyses
|
Single or several RCTs
Meta-analyses
|
Single or several RCTs
Meta-analyses
|
Single or several RCTs
Meta-analyses
|
Type of studies considered in the evidence of treatment harms
|
Observational studies
Single or several RCTs
|
Single or several RCTs
Meta-analyses
|
Treatment harms not reported
|
Treatment harms not reported
|
Heterogeneity of treatment effects assessed in the guideline
|
Yes
|
Yes
|
No
|
No
|
Application of treatment evidence to baseline risks
|
Methods to apply treatment evidence to baseline risks
|
Used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Unclear, presumably used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Not reported
|
Not reported
|
Assumptions specified when applying treatment evidence
|
'For every 30-mg/dL change in LDL-C, the relative risk for CHD is changed in proportion by about 30%, and the relative risk is set at 1.0 for LDL-C = 40 mg/dL.'
'For every 1% reduction in LDL-C levels, relative risk for major CHD events is reduced by approximately 1%.'
|
'Statins do not differ in their relative effectiveness in a number of subgroups: in women compared with men at a similar level of cardiovascular risk; in people with diabetes compared with people without diabetes; or in people aged over 65 years compared with people aged under 65 years.'
|
Not reported
|
Not reported
|
Development of treatment thresholds
|
Risk stratification in which different treatments were recommended
|
•10-year CHD risk > 20%
•10-year CHD risk 10 to 20%
•10-year CHD risk < 10%
|
•10-year CVD risk ≥20%
|
•0 to 1 CHD risk factor
•≥2 CHD risk factors and 10-year CHD risk < 20%
•≥2 CHD risk factors and 10-year CHD risk 10% to 20%
•CHD or CHD risk equivalent (10-year risk > 20%)
|
•10-year CHD absolute risk > 20%
•10-year CHD absolute risk 10% to 20%
•10-year CHD absolute risk < 10%
|
Methods to develop treatment thresholds
|
Unclear
|
Expert consensus
|
Referring to NCEP ATP-III guideline
|
Not reported
|
Explicitly planned benefit and harm assessment as the basis for making recommendations
|
No
|
No
|
No
|
No
|
Patient preferences considered when developing recommendations
|
No
|
No
|
No
|
No
|
Guideline title
|
MSC1
|
NICE2
|
ACCP
|
MSC2
|
Risk assessment tools
|
Risk prediction model
|
Framingham Risk Score (for patients without diabetes) and UKPDS Risk Engine (for patients with diabetes)
|
Framingham Risk Score
|
Framingham Risk Score
|
Framingham Risk Score or UKPDS Risk Engine for patients with diabetes
|
Outcome of interest and its timeframe
|
CHD (10 years)
|
CVD (CHD and stroke, 10 years)
|
CHD (10 years)
|
CHD (10 years)
|
Information on validation of the model provided in the guideline
|
No
|
Yes
|
No
|
No
|
Evidence of treatment effects
|
Treatment considered
|
Lifestyle management, pharmacologic treatment and desirable lipid results
|
Lifestyle advice and statin
|
Aspirin and vitamin K antagonists
|
Lifestyle management and antihypertensive drugs
|
Target population
|
Men aged > 40 years and women aged > 50 years
|
Adults aged 18 and older and who have established CVD or who are at high risk of developing CVD
|
Patients at risk for coronary artery disease
|
Non-pregnant adults (age 19 years and older) with hypertension
|
Type of studies considered in the evidence of treatment benefits
|
Other guidelines
|
Meta-analyses
|
Meta-analyses
|
Meta-analyses
|
Type of studies considered in the evidence of treatment harms
|
Treatment harms not reported
|
Meta-analyses
|
Single or several RCTs
Meta-analyses
|
Treatment harms not reported
|
Heterogeneity of treatment effects assessed in the guideline
|
No
|
Yes
|
Yes
|
No
|
Application of treatment evidence to baseline risks
|
Methods to apply treatment evidence to baseline risks
|
Not reported
|
Not reported
|
Unclear, presumably used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Assumptions specified when applying treatment evidence
|
Not reported
|
Not reported
|
Not reported
|
'This assumes 20% risk reduction of CHD based on average outcomes for appropriately used blood pressure lowering medications and statin medications.'
|
Development of treatment thresholds
|
Risk stratification in which different treatments were recommended
|
•Framingham CHD risk ≥20% without CHD
•Framingham CHD risk 10% to 19%
•Framingham CHD risk < 10%
|
•CVD risk < 20%
•CVD risk ≥20%
|
Moderate risk for a coronary event (10-year risk of a cardiac event > 10%)
|
Diagnosis of hypertension confirmed and CHD risk ≥20% over 10 years
|
Method to develop treatment thresholds
|
Referring to 2005 British Columbia guideline Diabetes Care
|
Referring to the NICE technology appraisal Statins for the Prevention of Cardiovascular Events
|
Unclear, presumably putting benefits and harms on the same scale and find a balance between them
|
Unclear
|
Explicitly planned benefit and harm assessment as the basis for making recommendations
|
No
|
Unclear
|
No
|
Unclear
|
Patient preferences considered when developing recommendations
|
No
|
No
|
No
|
No
|
Guideline title
|
USPSTF
|
UMHS1
|
ISCI
|
MQIC
|
Risk assessment tools
|
Risk prediction model
|
Framingham Risk Score
|
Framingham Risk Score
|
Framingham Risk Score
|
Framingham Risk Score
|
Outcome of interest and its timeframe
|
CHD (10 years) in men and stroke (10 years) in women
|
Hard CHD (myocardial infarction and coronary death, 10 years)
|
CHD (10 years)
|
CHD (10 years)
|
Information on validation of the model provided in the guideline
|
No
|
No
|
No
|
No
|
Evidence of treatment effects
|
Treatment considered
|
Aspirin
|
Lifestyle changes, drug therapy and LDL-C goals
|
Drug therapy and LDL goals
|
Drug therapy and goal for LDL-C
|
Target population
|
Men aged 45 to 79 years and women aged 55 to 79 years
|
Adults 20 to 75 years of age without familial or severe dyslipidemias
|
Adults 20 years and older and who are dyslipidemic
|
Adults ≥18 years
|
Type of studies considered in the evidence of treatment benefits
|
Meta-analyses
|
Treatment benefits reported but study type unclear
|
Single or several RCTs
Meta-analyses
|
Treatment benefits not reported
|
Type of studies considered in the evidence of treatment harms
|
Observational studies
|
Treatment harms reported but study type unclear
|
Single or several RCTs
Meta-analyses
|
Treatment harms not reported
|
Heterogeneity of treatment effects assessed in the guideline
|
Yes
|
Yes
|
No
|
No
|
Application of treatment evidence to baseline risks
|
Methods to apply treatment evidence to baseline risks
|
Used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Not reported
|
Assumptions specified when applying treatment evidence
|
There is 'a 32% risk reduction of MIs with regular aspirin use' (in men) and 'a 17% risk reduction of strokes with regular aspirin use' (in women).
'The risk for gastrointestinal bleeding increases with age.'
|
Not reported
|
Not reported
|
Not reported
|
Development of treatment thresholds
|
Risk stratification in which different treatments were recommended
|
•Men aged 45 to 59 years and 10-year CHD risk ≥4%; men aged 60 to 69 years and 10-year CHD risk ≥9%; men aged 70 to 79 years and 10-year CHD risk ≥12%
•Women aged 55 to 59 years and 10-year stroke risk ≥3%; women aged 60 to 69 years and 10-year stroke risk ≥8%; women aged 70 to 79 years and 10-year stroke risk ≥11%
|
•0 to 1 risk factors
•2+ risk factors and 10-year CHD risk < 10%
•2+ risk factors and 10-year CHD risk 10% to 20%
|
•0 to 1 risk factor and 10-year CHD risk < 10%
•2+ risk factors and 10-year CHD risk < 10%
•2+ risk factors and 10-year CHD risk 10% to 20%
•CHD or CHD equivalent and/or 10-year risk > 20%
|
•CHD or CHD risk equivalents 10-year risk > 20%
•2+ risk factors 10-year CHD risk ≤20%
•0 to 1 risk factor
|
Method to develop treatment thresholds
|
Putting benefits and harms on the same scale (events saved/in excess per 1,000 people) and find a balance between them
|
Expert consensus and referring to NCEP ATP-III guideline
|
Referring to NCEP ATP-III guideline
|
Referring to ICSI Lipid Management in Adults guideline
|
Explicitly planned benefit and harm assessment as the basis for making recommendations
|
Yes
|
No
|
No
|
No
|
Patient preferences considered for the development of recommendations
|
Yes
|
No
|
No
|
No
|
Guideline title
|
ES
|
NICE3
|
MSC3
|
ADA
|
Risk assessment tools
|
Risk prediction model
|
Framingham Risk Score, PROCAM and SCORE
|
UKPDS Risk Engine
|
UKPDS Risk Engine
|
Not specified, presumably Framingham Risk Score
|
Outcome of interest and its timeframe
|
10-year CHD risk (Framingham and PROCAM) and 10-year total cardiovascular mortality (SCORE)
|
CHD (10 years) in patients with diabetes
|
CHD (10 years) in patients with diabetes
|
CVD (CHD and stroke, 10 years)
|
Information on validation of the model provided in the guideline
|
Yes
|
Yes
|
No
|
No
|
Evidence of treatment effects
|
Treatment considered
|
Aspirin, LDL-C goals and non-HDL-C goals
|
Simvastatin and statin
|
Statin and lipid targets
|
Aspirin
|
Target population
|
Patients at high metabolic risk for CVD
|
People with type 2 diabetes
|
Non-pregnant adults with type 2 diabetes
|
Patients with type 1 or type 2 diabetes mellitus
|
Type of studies considered in the evidence of treatment benefits
|
Single or several RCTs
Meta-analyses
|
Single or several RCTs
Meta-analyses
|
Single or several RCTs
|
Meta-analyses
|
Type of studies considered in the evidence of treatment harms
|
Treatment harms reported but study type unclear
|
Single or several RCTs
|
Treatment harms not reported
|
Treatment harms reported but study type unclear
|
Heterogeneity of treatment effects assessed in the guideline
|
No
|
No
|
No
|
Yes
|
Application of treatment evidence to baseline risks
|
Methods to apply treatment evidence to baseline risks
|
Not reported
|
Not reported
|
Not reported
|
Unclear, presumably used evidence of relative risk reduction from RCT/meta-analysis and applied it to different absolute risks
|
Assumptions specified when applying treatment evidence
|
Not reported
|
Not reported
|
Not reported
|
Not reported
|
Development of treatment thresholds
|
Risk stratification in which different treatments were recommended
|
•Individuals over age 40 and 10-year risk for CHD > 10%
•10-year risk for CHD > 20%
•10-year risk for CHD 10% to 20%
•At least two major risk factors and 10-year risk for CHD < 10%
|
The cardiovascular risk exceeds 20% over 10 years
|
•Moderate risk (< 20% 10-year CHD risk)
•High risk (≥20% 10-year CHD risk)
|
•Adults with type 1 or type 2 diabetes at increased cardiovascular risk (10-year CVD risk > 10%)
•Adults with diabetes and 10-year CVD risk < 5%
•Adults with 10-year CVD risk 5% to 10%
|
Methods to develop treatment thresholds
|
Unclear, presumably putting benefits and harms on the same scale and find a balance between them to recommend using aspirin; referring to NCEP ATP-III guideline on LDL-C and non-HDL-C goals
|
Not reported
|
Not reported
|
Unclear, presumably putting benefits and harms on the same scale and find a balance between them
|
Explicitly planned benefit and harm assessment as the basis for making recommendations
|
No
|
No
|
No
|
No
|
Patient preferences considered when developing recommendations
|
No
|
Yes
|
No
|
No
|
Guideline title
|
UMHS2
|
NSGC
|
ASCO
|
NICE4
|
Risk assessment tools
|
Risk prediction model
|
NCI Breast Cancer Risk Assessment Tool
|
The guideline mentioned different models
|
NCI Breast Cancer Risk Assessment Tool
|
Nottingham Prognostic Index
|
Outcome of interest and its timeframe
|
Invasive breast cancer (5 years)
|
Absolute risk of developing breast cancer or the likelihood of carrying a BRCA1 or BRCA2 mutation (unclear timeframe)
|
Invasive breast cancer during the next 5-year period and up to age 90 (lifetime risk)
|
Survival (10 years)
|
Information on validation of the model provided in the guideline
|
No
|
No
|
Yes
|
No
|
Evidence of treatment effects
|
Treatment considered
|
Tamoxifen and raloxifene
|
Tamoxifen; oral contraceptives; prophylactic mastectomy, prophylactic bilateral salpingo-oophorectomy
|
Tamoxifen and raloxifene
|
Aromatase inhibitors
|
Target population
|
Adults age 18 and older (non-pregnant)
|
Individuals at risk for hereditary breast and ovarian cancer
|
Women at increased risk of breast cancer
|
Women with breast cancer
|
Type of studies considered in the evidence of treatment benefits
|
Treatment benefits reported but study type unclear
|
Treatment benefits reported but study type unclear
|
Single or several RCTs
Meta-analyses
|
Single or several RCTs
|
Type of studies considered in the evidence of treatment harms
|
Treatment harms reported but study type unclear
|
Treatment harms not reported
|
Single or several RCTs
Meta-analyses
|
Single or several RCTs
|
Heterogeneity of treatment effects assessed in the guideline
|
No
|
No
|
Yes
|
No
|
Application of treatment evidence to baseline risks
|
Methods to apply treatment evidence to baseline risks
|
Used evidence of relative risk reduction from the same risk profile population for which the recommendation was made
|
Not reported
|
Unclear
|
Unclear
|
Assumptions when applying treatment evidence
|
Not reported
|
Not reported
|
Not reported
|
Not reported
|
Development of treatment thresholds
|
Risk stratification in which different treatments were recommended
|
Women at high risk (5-year risk of invasive cancer ≥1.7%)
|
The guideline made risk-stratified recommendations, but it is unclear how they defined high risk, moderate risk and low risk
|
Premenopausal and postmenopausal women with a 5-year projected breast cancer risk ≥1.66% or with lobular carcinoma in situ
|
•Postmenopausal women with estrogen-receptor-positive early invasive breast cancer not at low risk (those in the Excellent Prognosis Group or Good Prognosis Group in the Nottingham Prognostic Index)
•Postmenopausal women with estrogen-receptor-positive early invasive breast cancer not at low risk and who have been treated with tamoxifen for 2 to 3 years
|
Method to develop treatment thresholds
|
Expert consensus
|
Not reported
|
Expert consensus
|
Unclear
|
Explicitly planned benefit and harm assessment as the basis for making recommendations
|
No
|
No
|
Yes
|
No
|
Patient preferences considered when developing recommendations
|
No
|
No
|
No
|
Yes
|