Global Cardiovascular Risk Assessment: Strengths and Limitations

Global cardiovascular (CV) risk assessment tries to answer the questions: who will benefit from intervention? And when should non-pharmacologic and pharmacologic treatment be started? Used for the assessment of CV risk in the presence of one main CV risk factor, the presence of previous CV disease, diabetes, chronic kidney disease, coronary heart disease and severely elevated single risk factors, are situations with a high or very high risk. For the majority of subjects without any of the above, a calculation of risk can help to decide the best management. The methodology of assessing global CV risk has both strength and limitations. Several computational methods have been developed to assess global CV risk but no risk estimation can consider all the potential risk factors. The most used score chart is the Framingham CardioVascular Risk Score, although in Europe the Systematic Coronary risk evaluation is widespread. The strengths of the global CV risk scores depend on the methodology applied at the time of construction: (a) appropriate statistical methods (representative sample, sufficient power, clear definition of the outcomes); (b) inclusion of appropriate risk factors (age, sex, conventional risk factors, and inclusion of others that can be relevant). Once developed, the function requires internal and external validity as well as calibration. There are several limitations, which have been solved with different approaches. In the case of hypertension, one element is introduced in the score charts, the presence of hypertension-induced organ damage offering a refinement of the approach to the global CV risk.