Cardiovascular Risk Assessment: Practical Tips for the Internal Medicine Specialist

Cardiovascular diseases remain the leading cause of mortality worldwide, and they also represent a significant burden in terms of health care expenditure, equipment use, therapeutic interventions and high medical resources consumption. Despite multiple preventive and management efforts, development of epidemiological and research programs along with the implementation of tools (calculators) for cardiovascular risk assessment during the last decades, cardiovascular diseases (CVD) continue to rise during 2025,^1,2 and it seems will be affecting our communities longer if there are no direct, coordinated and effective multidisciplinary actions. General Internal Medicine practice plays a vital role in preventing, diagnosing, treating, and addressing atherosclerotic cardiovascular disease (ASCVD) and other cardiovascular diseases (CVD). The Internal Medicine setting participates in the preliminary stages of primary prevention evaluating risk factors for cardiovascular disease, measuring them objectively. ^3,4.5 Equations or validated risk calculators were developed initially by the Framingham Heart Study investigators and were followed by several world scientific heart societies (American Heart Association, American College of Cardiology,⁶ European Society of Cardiology,⁷ European Association of Preventive Cardiology),⁸ etc. These tools were created, authenticated, used, and reconditioned in the last few decades. The most recent one (AHA PREVENT) includes more representative populations, cardiovascular-kidney-metabolic health factors (eGFR, HbA1c, obesity, heart failure), and a social deprivation index SDI (zip code). These new features were incorporated trying to estimate a 10-year and 30-year atherosclerotic cardiovascular ASCVD risk better, more precise, and closer to a realistic application.^9.10 As a fact, there is not a perfect calculator to measure the cardiovascular risk in each specific case. Knowing the statistical power of these calculators, their limitations, specific features of each evaluated individual, accessory tools (lipoprotein a, apolipoprotein B, coronary artery calcium CAC, etc.), clinical judgement, medical experience, the cardiovascular risk assessment could be personalized and reflect a legitimate probability of an atherosclerotic cardiovascular disease ASCVD risk to initiate medical actions that could impact outcomes significantly.^11,12,13,14 Based on the special characteristics of the Internal Medicine setting: unique skills on patient-centered care, integral evaluations, promoting primary prevention, applying the art of a shared decision-making rooted in trust, the primary care physician is considered invaluable for approaching, addressing, educating, implementing, and participating in cardiovascular risk assessment objectively. ^15,16,17.