The importance of total cardiovascular risk assessment in clinical practice

Abstract

Background: The Third Joint European Guidelines on Cardiovascular Disease (CVD) Prevention highlight the importance of total cardiovascular risk prediction in planning preventive strategies. Aim: To review the development of risk prediction systems in Europe and the practicalities of utilizing risk prediction in everyday clinical practice. Methods: Randomised clinical trials, cohort studies and current guidelines for the management of cardiovascular risk were reviewed. Relevant articles published between 1960 and 2004 were identified on PubMed and the Internet. Results: Several risk factors have been confirmed as major independent predictors of CVD, with their modification reducing cardiovascular risk. Total risk assessment is essential as multiple risk factors confer greater risk than the sum of their components. Framingham Heart Study data have been used as the basis for several risk prediction systems, which have been incorporated into numerous guidelines. However, these data are from a relatively small American cohort and tend to overestimate risk in some European populations. This and other limitations prompted the development of the SCORE (Systematic Coronary Risk Evaluation) risk charts using a much larger dataset from 12 European cohort studies. An electronic version of the charts, HeartScore, is now available to provide practitioners with an interactive risk prediction and management system that can be tailored to individual countries. Conclusion: Evidence-based risk assessment systems can facilitate logical, individually tailored risk management and contribute to better patient care. Secular changes in coronary heart disease (CHD) incidence and mortality as well as in risk factors such as obesity and diabetes mean that such systems should be capable of modification and evolution.