Assessing Cardiovascular Disease Risk and Responses to Preventive Therapies in Clinical Practice

Abstract

Purpose of Review

The aims of this review are to provide perspective on evaluation of relative and absolute cardiovascular disease (CVD) risk reductions for assessing the efficacy of preventive therapies and to summarize methods for evaluation of CVD risk in clinical practice.

Recent Findings

Major CVD risk factors can be used to stratify patients into risk categories. Results from recent trials reinforce the view that benefits of preventive therapies will be greatest in those with the highest absolute risk and in those with the most severe disturbance in the risk factor targeted. In evaluating clinical utility, it is necessary to assess the impact of an intervention on both relative and absolute risk. Quantitative risk scoring using major CVD risk factors is effective for identifying those at low, moderate, and high CVD risk. When there is uncertainty about the appropriate treatment strategy, additional testing may be used to refine risk assessment. This may include measurement of inflammatory markers, subclinical indicators of atherosclerosis (e.g., coronary artery calcium and ankle brachial index), urinary albumin/creatinine ratio, and the level of lipoprotein (a).

Summary

The benefit of a preventive therapy will generally be the greatest in those with the highest absolute risk and in those with the most severe disturbance in the risk factor targeted. Quantitative risk scoring with major CVD risk factors can be supplemented with additional testing for refinement of risk assessment in patients for whom decisions about pharmacotherapy, or the intensity of therapy, for risk factor modification are uncertain.

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Correspondence to Kevin C. Maki.

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Conflict of Interest

Dr. Maki reports grants and personal fees from Amgen, grants and personal fees from AstraZeneca, personal fees from Kowa, personal fees from Quest Laboratories, and grants from Regeneron, outside the submitted work. Dr. Dicklin reports grants from Amgen, AstraZeneca, and Regeneron, outside the submitted work.

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Maki, K.C., Dicklin, M.R. Assessing Cardiovascular Disease Risk and Responses to Preventive Therapies in Clinical Practice. Curr Atheroscler Rep 20, 23 (2018). https://doi.org/10.1007/s11883-018-0725-y

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Keywords

  • Cardiovascular risk
  • Risk assessment
  • Risk factors
  • Lipoprotein lipids
  • Inflammation
  • Subclinical cardiovascular biomarkers