Evaluating CMR
Assessing CVD Risk: Traditional Approaches
Limitations
- 1Key Points (1 page)
- 2Predicting CVD risk (1 page)
- 3Applicability of prediction models to different populations (2 pages)
- 4Limited risk prediction models in women (1 page)
- 5Exclusion of subjects with type 2 diabetes (2 pages)
- 6Exclusion of potential risk factors in prediction equations (1 page)
- 7Endpoints heterogeneity (1 page)
- 8References (1 page)
Exclusion of potential risk factors in prediction equations
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An additional limitation of some risk charts, such as the Framingham risk score and the SCORE project, is that the equations do not include some other potentially important risk predictors of CHD. For instance, these equations do not take into account family history of heart disease despite the widely accepted importance of family history of premature CHD in clinical practice. It has been shown that a validated positive family history of CHD doubled cardiovascular risk for men and led to a 70% increase (nonsignificant) in risk for women over 8 years (18). In addition, the Framingham risk equation and the SCORE chart do not include potentially relevant factors/markers such as blood glucose level, hemoglobin A1C, triglycerides, C-reactive protein, indices of intra-abdominal (visceral) obesity and ectopic fat deposition, and physical activity/fitness. For some of these variables, it was felt that they could not be included in global risk assessment because of their strong ties to other major risk factors—their added contribution to CHD risk estimation was therefore not clear (19). However, the exclusion of these risk factors does not mean that they are not clinically relevant. Many of them should in fact be considered when evaluating and managing patients at high CHD risk.
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