Cardiovascular risk
- 6 August 2012
- journal article
- review article
- Published by Wiley in British Journal of Clinical Pharmacology
- Vol. 74 (3), 396-410
- https://doi.org/10.1111/j.1365-2125.2012.04219.x
Abstract
Cardiovascular disease is a major, growing, worldwide problem. It is important that individuals at risk of developing cardiovascular disease can be effectively identified and appropriately stratified according to risk. This review examines what we understand by the term risk, traditional and novel risk factors, clinical scoring systems, and the use of risk for informing prescribing decisions. Many different cardiovascular risk factors have been identified. Established, traditional factors such as ageing are powerful predictors of adverse outcome, and in the case of hypertension and dyslipidaemia are the major targets for therapeutic intervention. Numerous novel biomarkers have also been described, such as inflammatory and genetic markers. These have yet to be shown to be of value in improving risk prediction, but may represent potential therapeutic targets and facilitate more targeted use of existing therapies. Risk factors have been incorporated into several cardiovascular disease prediction algorithms, such as the Framingham equation, SCORE and QRISK. These have relatively poor predictive power, and uncertainties remain with regards to aspects such as choice of equation, different risk thresholds and the roles of relative risk, lifetime risk and reversible factors in identifying and treating at-risk individuals. Nonetheless, such scores provide objective and transparent means of quantifying risk and their integration into therapeutic guidelines enables equitable and cost-effective distribution of health service resources and improves the consistency and quality of clinical decision making.Keywords
This publication has 161 references indexed in Scilit:
- Use of antidepressant medication and risk of type 2 diabetes: results from three cohorts of US adultsDiabetologia, 2011
- Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort studyThe Lancet, 2011
- 9p21 DNA variants associated with coronary artery disease impair interferon-γ signalling responseNature, 2011
- Effects of Combination Lipid Therapy in Type 2 Diabetes MellitusNew England Journal of Medicine, 2010
- Medication Adherence is a Mediator of the Relationship Between Ethnicity and Event-Free Survival in Patients With Heart FailureJournal of Cardiac Failure, 2010
- Association Between a Literature-Based Genetic Risk Score and Cardiovascular Events in WomenJAMA, 2010
- C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysisThe Lancet, 2009
- Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trialsThe Lancet, 2009
- Uric Acid and Cardiovascular RiskNew England Journal of Medicine, 2008
- THE INVERSE CARE LAWThe Lancet, 1971