Cardiovascular risk assessment - From individual risk prediction to estimation of global risk and change in risk in the population

The cardiovascular diseases are the leading cause of death in the world, especially because of myocardial infarction and stroke. Their beginning, however, starts many years earlier with the atherosclerotic process due to the cardiovascular risk factors, with different weights in the global risk. Our aim is to review the utilization of risk estimators in primary health care, through a comprehensive review of the literature and official national and international health data (OECD and WHO). The risk estimators aim to integrate the partial information of each factor in a global calculation able to help towards a better clinical reasoning in primary prevention. Besides the variables in the mathematical algorithm, estimators must consider also the factors not in the equation, but significant for decision making. Risk estimators are crucial in prevention, allowing to classify the risk in practical categories easy to use and to benefit the decision-making, more than trying to guess what will happen to the patient.

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Cardiovascular Risk Assessment in Hypertensive Patients

American Journal of Hypertension ◽

10.1093/ajh/hpab021 ◽

2021 ◽

Author(s):

Michael C Wang ◽

Donald M Lloyd-Jones

Keyword(s):

Blood Pressure ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Risk Prediction ◽

Clinical Management ◽

Prognostic Significance ◽

Quantitative Risk Assessment ◽

Cardiovascular Risk Assessment ◽

Hypertensive Patients ◽

Cardiovascular Risk Prediction

Abstract Hypertension is a highly prevalent and causal risk factor for cardiovascular disease (CVD). Quantititaive cardiovascular risk assessment is a new paradigm for stratifying hypertensive patients into actionable groups for clinical management and prevention of CVD. The large heterogeneity in hypertensive patients makes this evaluation complex, but recent advances have made CV risk assessment more feasible. In this review, we first describe the prognostic significance of various levels and temporal patterns of blood pressure. We then discuss cardiovascular risk prediction equations and the rationale of taking global risk into account in hypertensive patients. Finally, we review several adjunctive biomarkers that may refine risk assessment in certain patients. We observe that, beyond individual cross-sectional measurements, both short-term and long-term blood pressure patterns are associated with incident CVD; that current cardiovascular risk prediction performs well, and its incorporation into hypertension management is associated with potential population benefit; and that adjunctive biomarkers of target organ damage show the most promise in sequential screening strategies that target biomarker measurement to patients in whom the results are most likely to change clinical management. Implementation of quantitative risk assessment for CVD has been facilitated by tools and direct electronic health record integrations that make risk estimates accessible for counseling and shared decision making for CVD prevention. However, it should be noted that treatment does not return an individual to the risk of someone who never develops hypertension, underscoring the need for primordial prevention in addition to continued innovation in risk assessment.

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