Screening for Cardiovascular Risk in Asymptomatic Patients

Abstract

Cardiovascular disease is the number 1 cause of death in the western world and 1 of the leading causes of death worldwide. The lifetime risk of atherosclerotic cardiovascular disease (CVD) for persons at age 50 years, on average, is estimated to be 52% for men and 39% for women, with a wide variation depending on risk factor burden. Assessing patients' cardiovascular risk may be used for the targeting of preventive treatments of individual patients who are asymptomatic but at sufficiently high risk for the development of CVD. Risk stratifying patients for CVD remains challenging, particularly for those with low or intermediate short-term risk. Several algorithms have been described to facilitate the assessment of risk in individual patients. We describe 6 risk algorithms (Framingham Risk Score for coronary heart disease events and for cardiovascular events, Adult Treatment Panel III, SCORE [Systematic Coronary Risk Evaluation] project, Reynolds Risk Score, ASSIGN [Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network/SIGN to Assign Preventative Treatment], and QRISK [QRESEARCH Cardiovascular Risk Algorithm]) for outcomes, population derived/validated, receiver-operating characteristic, variables included, and limitations. Areas of uncertainty include 10-year versus lifetime risk, prediction of CVD or coronary heart disease end points, nonlaboratory-based risk scores, age at which to start, race and sex differences, and whether a risk score should guide therapy. We believe that the best high-risk approach to CVD evaluation and prevention lies in routine testing for cardiovascular risk factors and risk score assessment. We recommend that health care providers discuss the global cardiovascular risk and lifetime cardiovascular risk score assessment with each patient to better explain each patient's future risk. Appropriate intervention, guided by risk assessment, has the potential to bring about a significant reduction in population levels of risk.

Genetics: Implications for Prevention and Management of Coronary Artery Disease

“…Although current clinical risk prediction scores for CAD perform relatively well compared with scores for other chronic diseases, substantial room for improvement exists, as a large pool of individuals with incident events carry either only 1 modifiable risk factor or only borderline risk factors (118)(119)(120).…”

Correlation between Obesity and Coronary Heart Disease Risk among Saudi Subjects at Madinah Region

“…Using the risk stratification approach as an indicator rather than emphasizing results of each individual cardiovascular risk factor will help in improving the awareness of health workers and beneficiaries on the joint adverse effects of clustering cardiovascular risk factors on cardiovascular health, and the importance of addressing all of them as a package [28]. Poor physical activity level of adult Saudis negatively impacts their health related-quality of life [12,21].…”

Impact of the Inflammatory and Ischemic Heart Disease Markers Into the Overall Cardiovascular Mortality in Senile Citizens of a Large City (The Data From Sahr Trial)

“…В исследовании WHS (Women's Health Study), была показана взаимосвязь между уровнем СРБ и раз-витием сердечно-сосудистых осложнений (ССО) [20]. Оказалось, что вероятность развития неблагоприят-ных исходов возрастала более чем в два раза при уровне СРБ >2 мг/л, при этом прогностическая значи-мость СРБ не зависела от "традиционных" ФР (гипер-холестеринемия, АГ, курение и СД) [21].…”