The Importance of Cardiovascular Risk Assessment
The risk of cardiovascular disease represents a challenge in spite of prevention and all treatment efforts. We have to find the best way to evaluate risk, probably based on new concepts.
Why is risk assessment necessary?
The first clinical symptoms of arterial disease do not indicate the onset of disease. Decades pass before manifestation, during which time the disease develops in silence, without symptoms. It is therefore evident, that by determining the risk of asymptomatic, apparently healthy individuals and by identifying the early, treatable stages of the disease, we contribute to the long-term health of the individual.
In the case of patients where cardiovascular disease is not clinically established, in addition to analyzing the well-known, traditional risk factors, assessing risk while taking alternative factors into account significantly improves the diagnosis of cardiovascular risk. The traditional risk factors are far from sufficient in and of themselves in determining risk status, necessitating the search for new risk factors. In the past few decades, international medical/scientific interest has turned to those clinically useful as well as cost-effective methods that, within the primary framework of prevention, detect developments prior to manifestation of the disease, in a patient- and physician-friendly manner, and which are also simple and useful as part of basic care and therapeutic strategy. This new direction, the non-invasive detection of subclinical arterial disease unequivocally improves the identification of high-risk individuals.
It’s clear that we must not only treat myocardial infarction, stroke and peripheral arterial disease well, we must prevent it. After all, prevention is simpler and more cost-effective than intensive care. Given the fact that several decades pass between the recognition of risk factors, through the preclinical target organ damage to the manifest vascular event, there is (would be) time to identify high-risk, vulnerable individuals with diagnostic screening. The timely start of preventive treatment (in terms of lifestyle and medication) could prevent a significant share of heart attack and stroke incidents. Based on large studies, it can generally be concluded that effective blood pressure reduction treatment reduces the risk of heart attack and stroke, primarily if we use therapies that have a positive effect on arterial walls as well as central hemodynamics.
The limitations of traditional risk scores