The estimate of cardiovascular risk. Theory, tools and problems

The present article reviews the epidemiological and statistical bases of the multivariate prediction of cardiovascular events and its transformation into practical tools for primary prediction. The problems with the use of tools derived from studies conducted in populations that are different from those in which the estimate is being made are documented. A description is made of a number of predictive tools produced in the past and recently included in risk manuals, charts and computer programs and their main characteristics are outlined. The problems in the origin, structure and use of the chart suggested by the Task Force of three European Scientific Societies, including the marked overestimate of the risk when this tool is applied to Italian data, are reviewed in detail. The need to use predictive tools derived from Italian population studies is stressed. Comments are made on the difficult choice between the use of the absolute and relative risks for the identification of high-risk subjects to be treated on an individual basis for primary prevention of major cardiovascular diseases.