How the Reynolds Score Is Used to Calculate Cardiac Risk in Women

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Accurately estimating cardiovascular risk is important, because it allows you (and your doctor) to decide how aggressive you ought to be in taking the steps available to you to reduce that risk.

For instance, most guidelines for prescribing statin drugs rely heavily on an accurate assessment of a person’s estimated 10-year risk of having a serious cardiovascular event (such as heart attack or stroke).

In the attempt to make these estimates as accurate as possible, several risk estimators have been developed over the years. Each has its own strengths and weaknesses.

One legitimate criticism that has been leveled against most of these risk calculators — in particular, the famous Framingham score— is that they have not been as accurate in women as in men. “Standard” risk calculators have underestimated the risk of heart attack in women by as much as 20%.

To try to rectify this shortcoming, in 2007 a new risk calculator was validated that was specifically developed for women without diabetes. It is called the Reynolds risk calculator, and it appears to be more useful in women than many other similar calculators. (A variant of the Reynolds risk calculator was later validated for men, also.)

“Standard” methods of estimating cardiovascular risk in women tend to underestimate the actual risk. The Reynolds Risk Calculator was originally developed specifically to improve the estimation of cardiac risk in women.

The Importance of Estimating Your Cardiac Risk

For people whose cardiovascular risk is elevated, an aggressive program of risk reduction can substantially lower the odds of death or disability from heart disease or stroke.

Many of the steps that can be taken to reduce cardiovascular risk, however, can be inconvenient, difficult, or expensive. Engaging in regular exercise, eating a heart-friendly diet, losing weight, and quitting smoking can take a high level of commitment and motivation, and taking prescription drugs (such as statins) costs money and exposes you to possible side effects.

Making a formal estimate of your 10-year risk of having a heart attack, needing a stent, having a stroke, or dying of cardiovascular disease can provide you (and your doctor) with the motivation you may need to do the things necessary to significantly reduce that risk.

An accurate risk calculator, therefore, is a very useful tool.

How the Reynolds Risk Score Is Calculated

The Reynolds Risk Score was designed specifically for women in an attempt to make the cardiovascular risk estimate more accurate. Specifically, the Reynolds risk calculator takes into account (in addition to other factors) a family history of premature heart disease (which implies a genetic predisposition to cardiovascular disease), and also CRP levels (a marker of inflammation). These two risk factors are thought to be more predictive of heart disease in women than in men.

The Reynolds score is based on the following risk factors:

  • Age
  • Current smoker (yes or no)
  • Systolic blood pressure
  • Total cholesterol
  • HDL cholesterol
  • CRP level
  • Mother or father with heart attack before age 60 (yes or no)

Notably, diabetes was not included in the calculation of this risk score. This is because people with diabetes are already known to have a very high cardiovascular risk, and using a risk calculator like this one adds little or no additional useful information.

The cardiovascular outcomes that were used in validating the Reynolds Score for women were: cardiovascular death, non-fatal heart attack, non-fatal stroke, or the need for bypass surgery or a stent.

Effectiveness of the Reynolds Risk Calculator for Women

The score was validated by following a group of 25,000 healthy American women 45 years old or older (who, in particular, did not have diabetes) for an average of 10 years.

The Reynolds Risk Score score accurately classified the actual risk of many more women than did the usual predictive models. In fact, 40 - 50% of women who normally would be classified as having intermediate risk were reclassified by the Reynolds Score as either low or high risk — thus potentially allowing a much more targeted approach to risk factor management.

As noted, the Reynolds score originally was specifically developed for women. A similar study has now been conducted in men, and a separate Reynolds Risk Score has now been validated for men.

Use of the Reynolds Risk Calculator

The Reynolds Risk Score calculator can be found here (for both men and women). It asks several simple questions and immediately returns a 10-year risk score. (That is, it tells you the estimated probability that you will have a cardiovascular event within the next 10 years.) It also allows you to see readily how your risk would be improved if would change one or more of these risk factors. 

For instance, if you are a smoker you would simply need to enter “no” for the smoking question and the calculator will show you roughly how much your 10-year risk might be reduced if you were to quit.

To use the Reynolds risk score calculator, you need to know your blood pressure readings, and several important blood test results: total cholesterol, HDL, and CRP.

A Word From Verywell

The Reynolds Risk Score for women (and also for men) is a risk calculator that places more emphasis on CRP levels and family history than other, more commonly used risk calculators. Experts who believe CRP to be an important determinant of cardiovascular risk tend to place great importance on the Reynolds Risk Score.

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Article Sources

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  • Ridker PM, Buring JE, Rifai N, Cook NR. Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women: The Reynolds Risk Score. JAMA 2007; 297:611.

  • Ridker PM, Paynter NP, Rifai N, et al. C-reactive Protein and Parental History Improve Global Cardiovascular Risk Prediction: the Reynolds Risk Score for Men. Circulation 2008; 118:2243