Measures of global risk: old versus new methods

It is clear that atherosclerotic arterial disease has a multifactorial aetiology. Furthermore relatively modest elevations of two or more risk factors frequently coexist in individuals to produce a significant impact on the likelihood of a cardiovascular event. Nevertheless clinical practice has tended to be unifactorial, with physicians concentrating on single risk factors in isolation. Various scores using data on several risk factors have therefore been developed to help physicians assess which of their patients are most at risk and therefore most merit intervention. This global risk assessment is increasingly recognised in management guidelines as a reasonable way of guiding treatment. Indeed intervention strategies that do not target those at highest cardiovascular risk--(and currently available risk scores do this more efficiently than physicians' judgement)--are less likely to be cost effective. It must be acknowledged however that all risk scores have limitations and hence whichever method is used should be used to guide rather than rule practice.