An urgent matter-identifying your patients' cardiovascular risk and improving their outcomes. Assessing...

Given the Growing Prevalence of coronary heart disease (CHD) in the United States, risk assessment and reduction remain fundamental to family medicine practice. Risk assessment in cardiovascular disease is a constantly evolving field. The literature can be overwhelming; more than 4300 papers on the topic of CHD and risk were published in 2008 alone. Staying current with new, important developments in cardiovascular risk assessment clearly is challenging for most family physicians. Family physicians identify cardiac risk to prevent first cardiac events in their otherwise healthy patients and recurrent events in their patients with existing CHD. The first step in reaching primary prevention goals is to determine each individual patient's 10-year risk of CHD. Risk assessment instruments traditionally have viewed low-density lipoprotein cholesterol (LDL-C) levels as a cornerstone of individual risk and a principal target for therapeutic intervention. Although risk assessment tools are helpful, many may not be useful to family physicians because they may be cumbersome, may measure individual risk components rather than global risk, and may require excessive time to complete. Nevertheless, some form of quantitative risk assessment is useful. Traditional global risk assessment instruments may underestimate risk, especially in asymptomatic patients with subclinical atherosclerosis. Emerging data about the role of biomarkers and the benefits of aggressive reduction in LDL-C suggest the need for a paradigm shift in risk attribution and intervention for primary care patients. Risk assessment strategies and new data about cardiovascular risk of interest to family physicians are presented here.