As cardiovascular disease is the number one cause of death in the Western world, screening for cardiovascular risk must be improved to target asymptomatic individuals as well as high-risk subjects. The aim of this paper was to review the situation regarding the assessment of cardiovascular risk in asymptomatic patients. The authors described six algorithms that have been developed to facilitate the assessment of 10-year risk prediction of coronary heart disease events in individual patients. The well-known Framingham Risk Score, validated mostly for North Americans, was after adapted and incorporated into the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) to add screening for and treatment of dyslipidemia. The SCORE (Systematic Coronary Risk Evaluation) project was validated for European patients. As for the Reynolds Risk Score, it was initially designed to develop and validate an algorithm for global cardiovascular risk assessment in healthy women. Compared to the Framingham Risk Score and SCORE algorithms, the Reynolds Score included data of parental history of premature coronary heart disease and high sensitive C-reactive protein. Moreover, ASSIGN (Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network/SIGN to Assign Preventative Treatment) was developed in a Scottish population and was novel because the authors included an index of social status. Finally, the QRISK (QRESEARCH Cardiovascular Risk Algorithm) risk score, which was derived from a large United Kingdom primary care population, also included social deprivation in its 10-year risk assessment of cardiovascular disease (CVD). Several areas of uncertainty remain concerning the assessment of cardiovascular risk in asymptomatic patients. The authors highlighted the importance of predicting lifetime risk in addition to the short-term 10-year risk estimate in order to inform and motivate individuals to adopt healthy lifestyle habits. They suggested the inclusion of softer endpoints to reduce the risk of a future hard endpoint. They also underlined the necessity of using nonlaboratory-based risk scores for certain areas of the world, of assessing younger population with high lifetime predicted risk, and of taking into account racial and sex differences in CVD risk estimation. Thus, the authors recommended routine testing for cardiovascular risk factors and risk score assessment for high-risk CVD evaluation and prevention. Moreover, they concluded that the use of a global and lifetime cardiovascular risk score is the best way to identify a greater number of patients who will take advantage of early risk reduction strategies such as aggressive lifestyle changes or medication.
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