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Cardiovascular risk assessment beyond Systemic Coronary Risk Estimation: a role for organ damage markers
Massimo Volpe1, Allegra Battistoni, Giuliano Tocci
1Cardiology Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy. massimo.volpe@uniroma1.it
Insights
Adding organ damage markers like left ventricular hypertrophy (LVH) and microalbuminuria (MAU) to cardiovascular risk scores improves patient assessment. This enhances cardiovascular risk prediction and primary prevention recommendations.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers
Background:
- Current cardiovascular risk assessment relies on tools like the Systemic Coronary Risk Estimation (SCORE) chart.
- These charts do not account for subclinical organ damage, which independently influences cardiovascular risk.
- Incorporating organ damage markers can refine individual risk profiles.
Purpose of the Study:
- To evaluate the impact of integrating organ damage indexes with SCORE charts for improved cardiovascular risk assessment.
- To determine if adding markers like left ventricular hypertrophy (LVH), estimated glomerular filtration rate (eGFR), microalbuminuria (MAU), and metabolic syndrome enhances risk stratification.
Main Methods:
- A literature search was conducted on PubMed for studies published after 2000.
- Included studies focused on the predictive value of LVH, eGFR, MAU, and metabolic syndrome in relation to SCORE risk profiles.
- Selected trials were interventional or observational with at least 200 patients.
Main Results:
- The presence and number of organ damage markers correlate with increased cardiovascular risk, independent of SCORE.
- The impact of specific organ damage markers varies within high-risk categories.
- Combined models using SCORE and organ damage markers significantly improve risk stratification and may influence primary prevention strategies.
Conclusions:
- Evidence supports the clinical benefit of incorporating simple organ damage markers into existing risk charts.
- This integration offers a tangible advantage for cardiovascular risk prediction.
- Enhanced risk assessment can lead to more tailored primary prevention recommendations.
Background:
Cardiovascular risk assessment in the clinical practice is mostly based on risk charts, such as Framingham risk score and Systemic Coronary Risk Estimation (SCORE). These enable clinicians to estimate the impact of cardiovascular risk factors and assess individual cardiovascular risk profile. Risk charts, however, do not take into account subclinical organ damage, which exerts independent influence on risk and may amplify the estimated risk profile. Inclusion of organ damage markers in the assessment may thus contribute to improve this process.
Objective:
Our aim was to evaluate the influence of implementation of SCORE charts with widely available indexes of organ damage, with the purpose to ameliorate individual risk assessment.
Methodology:
We searched www.Pubmed.gov for evidence about the predictive value of left ventricular hypertrophy (LVH), estimated glomerular filtration rate (eGFR), microalbuminuria (MAU) and metabolic syndrome on different risk profiles estimated by SCORE. Interventional and observational trials including at least 200 patients and published after 2000 were selected.
Results:
The presence of organ damage as well as the number of abnormal parameters indicating organ damage is associated with increased cardiovascular risk, independently of SCORE. In the area of high risk, the impact of different markers of organ damage is heterogeneous. Combined risk models of SCORE and subclinical organ damage have major impact on risk stratification and may impact on recommendation in primary prevention in all SCORE categories.
Conclusion:
Available evidence suggests a tangible clinical advantage of adding the evaluation of simple organ damage markers to risk charts in cardiovascular risk prediction.
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