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Risk stratification in cardiovascular disease primary prevention: scoring systems, novel markers, and imaging techniques

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Abstract
The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A2, genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.
Keywords
carotid plaques, C-reactive protein, primary prevention, risk stratification, CORONARY-HEART-DISEASE, INTIMA-MEDIA THICKNESS, C-REACTIVE PROTEIN, LEFT-VENTRICULAR HYPERTROPHY, INCIDENT ISCHEMIC-STROKE, APOLIPOPROTEIN-A-I, MIDDLE-AGED MEN, MYOCARDIAL-INFARCTION, PHOSPHOLIPASE A(2), ATHEROSCLEROSIS RISK, carotid intima-media thickness, cardiovascular disease

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Citation

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Chicago
Zannad, Faiez, Gui De Backer, Ian Graham, Matthias Lorenz, Giuseppe Mancia, David A Morrow, Željko Reiner, et al. 2012. “Risk Stratification in Cardiovascular Disease Primary Prevention: Scoring Systems, Novel Markers, and Imaging Techniques.” Fundamental & Clinical Pharmacology 26 (2): 163–174.
APA
Zannad, F., De Backer, G., Graham, I., Lorenz, M., Mancia, G., Morrow, D. A., Reiner, Ž., et al. (2012). Risk stratification in cardiovascular disease primary prevention: scoring systems, novel markers, and imaging techniques. FUNDAMENTAL & CLINICAL PHARMACOLOGY, 26(2), 163–174.
Vancouver
1.
Zannad F, De Backer G, Graham I, Lorenz M, Mancia G, Morrow DA, et al. Risk stratification in cardiovascular disease primary prevention: scoring systems, novel markers, and imaging techniques. FUNDAMENTAL & CLINICAL PHARMACOLOGY. 2012;26(2):163–74.
MLA
Zannad, Faiez, Gui De Backer, Ian Graham, et al. “Risk Stratification in Cardiovascular Disease Primary Prevention: Scoring Systems, Novel Markers, and Imaging Techniques.” FUNDAMENTAL & CLINICAL PHARMACOLOGY 26.2 (2012): 163–174. Print.
@article{3057089,
  abstract     = {The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A2, genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.},
  author       = {Zannad, Faiez and De Backer, Gui and Graham, Ian and Lorenz, Matthias and Mancia, Giuseppe and Morrow, David A and Reiner, \v{Z}eljko and Koenig, Wolfgang and Dallongeville, Jean and Macfadyen, Robert J and Ruilope, Luis M and Wilhelmsen, Lars},
  issn         = {0767-3981},
  journal      = {FUNDAMENTAL \& CLINICAL PHARMACOLOGY},
  keyword      = {carotid plaques,C-reactive protein,primary prevention,risk stratification,CORONARY-HEART-DISEASE,INTIMA-MEDIA THICKNESS,C-REACTIVE PROTEIN,LEFT-VENTRICULAR HYPERTROPHY,INCIDENT ISCHEMIC-STROKE,APOLIPOPROTEIN-A-I,MIDDLE-AGED MEN,MYOCARDIAL-INFARCTION,PHOSPHOLIPASE A(2),ATHEROSCLEROSIS RISK,carotid intima-media thickness,cardiovascular disease},
  language     = {eng},
  number       = {2},
  pages        = {163--174},
  title        = {Risk stratification in cardiovascular disease primary prevention: scoring systems, novel markers, and imaging techniques},
  url          = {http://dx.doi.org/10.1111/j.1472-8206.2011.01023.x},
  volume       = {26},
  year         = {2012},
}

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