Value and Limitations of Existing Scores for the Assessment of Cardiovascular Risk

Abstract

Atherosclerotic cardiovascular diseases (CVDs) are the biggest causes of death worldwide. In most people, CVD is the product of a number of causal risk factors. Several seemingly modest risk factors may, in combination, result in a much higher risk than an impressively raised single factor. For this reason, risk estimation systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies. In this article, the performances of the major risk estimation systems are reviewed. Most perform usably well in populations that are similar to the one used to derive the system, and in other populations if calibrated to allow for different CVD mortality rates and different risk factor distributions. The effect of adding "new" risk factors to age, sex, smoking, lipid status, and blood pressure is usually small, but may help to appropriately reclassify some of those patients who are close to a treatment threshold to a more correct "treat/do not treat" category. Risk estimation in the young and old needs more research. Quantification of the hoped-for benefits of the multiple risk estimation approach in terms of improved outcomes is still needed. But, it is likely that the widespread use of such an approach will help to address the issues of both undertreatment and overtreatment.

ESC/EAS Guidelines for the management of dyslipidaemias

“…Risk age has been shown to be independent of the CV endpoint used, 51,52 which bypasses the dilemma of whether to use a risk estimation system based on CVD mortality or on the more attractive but less reliable endpoint of total CVD events. Risk age can be used in any population regardless of baseline risk or secular changes in mortality, and therefore avoids the need for recalibration.…”

Carotid ultrasonography in the assessment of cardiovascular risk

“…These scores are simple to use in evaluating CVR; however, in some cases the estimate is suboptimal, particularly in subgroups of the general population (for example, those at low or intermediate risk), since they vary widely in terms of the background risk in study populations, predictors and outcomes considered [24][25][26][27][28][29]. Other limitations of these scores include a substantial underestimation of lifetime risk, with a potential misclassification of high-risk subjects at low or intermediate CVR [30].…”

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

“…Недавно был опубликован обзор их значения и ограничений [49]. Модель систематической оценки коронарного риска (SCORE) была разрабо-тана по результатам крупных европейских когорт-ных исследований.…”