We propose to assess the role of cardiovascular disease (CVD) risk estimation in veterans without cancer or other major illnesses and compare the utility of using US national guideline estimates from ATP4 versus VA-specific formulations developed from VISN 1 and VISN 7. The core variables that will be used include traditional risk factors such age, sex, race, blood pressure, smoking, cholesterol, HDL cholesterol and diabetes status. In addition, we propose to identify the best ways to assess CVD risk in veterans with diabetes mellitus and in veterans who have already experienced a CVD event. We will evaluate the precision and accuracy of the ATP4 estimating equations in the VA and separately develop CVD risk equations using ATP4 variables to evaluate the best approach to estimate CVD risk in veterans. This critical evaluation of the risk of CVD in veterans is aimed to provide effective and convenient risk assessment tools - that in the future could be incorporated into clinical care for outpatient veterans and has the potential to guide CVD preventive therapy within the VA so that resources can be aligned to intervene appropriately with cardiovascular preventive services in veterans at high risk for developing a future CVD event. This proposal has direct relevance to the health risks of risky behavior (cigarette smoking), women's health, and patient-centered care.
This project will provide evidence-based data from the experience of VISN 1 and VISN 7 to estimate risk for CVD in veterans and will address VA research needs related to the risky behavior of smoking, women's health, and patient-centered care. Results will permit greater individualization of risk factor management. Within the VA there is a higher prevalence of smoking, obesity, and lack of physical activity. It is likely that the CVD rates in the VA are greater than what would be expected across the USA for their age, sex, and the burden of CVD risk factors. Results from this study are likely to lead to more personalized treatment of risk factors and CVD risk than what has been available to veterans in the past.