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Tools for Cardiovascular Risk Assessment in Clinical Practice

  • Novel + Emerging Risk Factors (K Nasir and R Santos, Section Editors)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Precise risk stratification of atherosclerotic cardiovascular disease guides best management and therefore is a public health priority. In addition to risk estimation using traditional risk factors, tools such as coronary artery calcium, high-sensitivity C-reactive protein, ankle-brachial index and carotid imaging, and clinical features such as family history of premature coronary heart disease may offer opportunities for a more personalized risk assessment. In this review, we discuss the strengths and limitations of each of these tools, focusing on the evidence provided by the latest studies relevant to the field. Among them, coronary artery calcium currently stands out as the most powerful tool for cardiovascular risk assessment, as recognized by the 2013 ACC/AHA Risk Assessment Guideline. Recent studies have expanded our knowledge regarding its value for improving the detection of both low and high absolute risk within clinically relevant subgroups, as well as for cost-effectively guiding preventive therapy allocation.

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Abbreviations

ABI:

Ankle-brachial index

ACC/AHA:

American College of Cardiology/American Heart Association

ASCVD:

Atherosclerotic cardiovascular disease

CAC:

Coronary artery calcium

CAC = 0:

Coronary artery calcium score of zero

CIMT:

Carotid intima-media thickness

CKD:

Chronic kidney disease

CT:

Computed tomography

CVD:

Cardiovascular disease

hsCRP:

High-sensitivity C-reactive protein

MRI:

Magnetic resonance imaging

PAD:

Peripheral arterial disease

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Acknowledgments

MC-A was funded by a research grant from the Spanish Society of Cardiology. SSM is supported by the Pollin Cardiovascular Prevention Fellowship, Marie-Josée and Henry R Kravis endowed fellowship, and a National Institutes of Health training grant (T32HL07024). RSB is supported by the Kenneth Jay Pollin Professorship in Cardiology.

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Conflict of Interest

Michael Blaha served on an Advisory Board for Pfizer and Luitpold Pharmaceuticals and received grant support from the FDA, all outside of the scope of the present work. Roger Blumenthal, Miguel Cainzos-Achirica and Kieran Eissler have no relevant disclosures to report. Seth Martin is listed as a co-inventor on a pending patent filed by Johns Hopkins University for a method of low-density lipoprotein cholesterol estimation.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA

    Miguel Cainzos-Achirica, Michael J. Blaha & Seth S. Martin

  2. Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Carnegie 568A, Baltimore, MD, 21287, USA

    Miguel Cainzos-Achirica, Kieran Eissler, Michael J. Blaha, Roger S. Blumenthal & Seth S. Martin

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  1. Miguel Cainzos-Achirica
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  2. Kieran Eissler
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  3. Michael J. Blaha
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  4. Roger S. Blumenthal
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  5. Seth S. Martin
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Correspondence to Seth S. Martin.

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This article is part of the Topical Collection on Novel and Emerging Risk Factors

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Cainzos-Achirica, M., Eissler, K., Blaha, M.J. et al. Tools for Cardiovascular Risk Assessment in Clinical Practice. Curr Cardiovasc Risk Rep 9, 28 (2015). https://doi.org/10.1007/s12170-015-0455-4

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