The art of cardiovascular risk assessment

Abstract

Cardiovascular disease (CVD) remains the leading cause of death in the United States. Healthcare expenditures have been principally allocated toward treatment of CVD at the end of the health/disease continuum, rather than toward health promotion and disease prevention. A focused effort on both primordial and primary prevention can promote cardiovascular health and reduce the burden of CVD. Risk-factor assessment for predicting atherosclerotic CVD events serves as the foundation of preventive cardiology and has been driven by population-based scoring algorithms based on traditional risk factors. Incorporating individual nontraditional risk factors, biomarkers, and selective use of noninvasive measures may help identify more at-risk patients as well as truly low-risk individuals, allowing for better targeting of treatment intensity. Using a combination of validated population-based atherosclerotic CVD risk-assessment tools, nontraditional risk factors, social health determinants, and novel markers of atherosclerotic disease, we should be able to improve our ability to assess CVD risk. Through scientific evidence, clinical judgment, and discussion between the patient and clinician, we can implement an effective evidence-based strategy to assess and reduce CVD risk.

Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries

“…The advantages of CMR are the non-invasive procedure, the use of non-toxic contrast agents and the three dimensional imaging capacity 70 There is evidence that inflammation contributes to the initiation and progression of atherosclerosis. High-sensitivity C-reactive protein (hsCRP) is an acute-phase reactant that measures subclinical systemic inflammation 83 . It is not clear whether inflammation simply is a result of the atherosclerotic process or if it is a major driver.…”

Cardiac Troponins As Biomarkers for Cardiac Disease

“…Cardiovascular disease (CVD) is a leading cause of death, morbidity and hospitalization worldwide [1][2][3]. Patient risk stratification is a crucial goal, as it informs therapy and follow-up strategies, with the ultimate goal of impacting on the natural history of the disease.…”

“…Assessing the prognostic accuracy of a novel cardiovascular biomarker is very complex [3,6,7]. According to the principles of Evidence-Based Laboratory Medicine, a biomarker should not only be an independent predictor of outcome in multiple regression models, but also influence patient management [8], which is the prerequisite for cost-efficacy [5,8].…”

Risco Cardiovascular e Elegibilidade Para Estatina na Prevenção Primária: Comparação Entre a Diretriz Brasileira e a Diretriz da AHA/ACC

“…Uma reavaliação da estratificação de risco em mulheres na diretriz brasileira pode ser sugerida. 4,20,21 Além disso, conforme diretrizes recentes têm enfatizado, a decisão sobre o uso de estatina na prevenção primária deve idealmente ser tomada após uma discussão com o paciente sobre os riscos e benefícios da terapia. 4 Finalmente, os escores de risco utilizados neste estudo não foram validados ou calibrados na população brasileira.…”