Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques.
Authors
Zannad, FaiezDe Backer, Guy
Graham, Ian
Lorenz, Matthias
Mancia, Giuseppe
Morrow, David A
Reiner, Zeljko
Koenig, Wolfgang
Dallongeville, Jean
Macfadyen, Robert J
Ruilope, Luis M
Wilhelmsen, Lars
Affiliation
Centre for Clinical Investigation, Institut Lorrain du Coeur et des Vaisseaux, CHU Brabois, 54500 Vandoeuvre, France. f.zannad@chu-nancy.frIssue Date
2012-04MeSH
Biological MarkersCardiovascular Diseases
Clinical Trials as Topic
Diagnostic Imaging
Drug Design
Humans
Primary Prevention
Research Design
Risk Assessment
Metadata
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Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques. 2012, 26 (2):163-74 Fundam Clin PharmacolPublisher
Fundamental & clinical pharmacologyJournal
Fundamental & clinical pharmacologyDOI
10.1111/j.1472-8206.2011.01023.xPubMed ID
22220636Abstract
The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.Item Type
ArticleLanguage
enISSN
1472-8206ae974a485f413a2113503eed53cd6c53
10.1111/j.1472-8206.2011.01023.x
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