Evaluating CMR

Endpoints heterogeneity

Another factor to consider when comparing different risk assessment algorithms is endpoints heterogeneity, which sometimes makes it difficult to compare these prediction tools. The Framingham Heart Study predicts total CHD risk, including angina pectoris, recognized and unrecognized MI, coronary insufficiency (unstable angina), and CHD deaths, whereas PROCAM only includes “hard” coronary events such as acute MI and CHD deaths as the primary coronary endpoint. The SCORE project only considers fatal CVD as the endpoint whereas the CUORE project estimates the risk of fatal and non-fatal major coronary events. In this regard, the Framingham risk score is limited to predicting total CHD risk and cannot predict the development of other heart or vascular diseases. Furthermore, non-coronary CVD is important because it represents a significant proportion of all cardiovascular events, especially in some European regions with low rates of CHD (3). Regarding the SCORE chart, one of its major limitations is the fact that it is derived from mortality data instead of fatal and non-fatal events. This is a notable limitation given that mortality does not appear to be an appropriate indicator of CVD frequency in European countries (20).

Another possible limitation of the Framingham risk score is that it does not predict CHD risk beyond 10 years. Lifetime risk estimates of CHD are very much needed, in particular for the ever-expanding number of young adults with abdominal obesity, features of the metabolic syndrome, and even type 2 diabetes.

Despite their limitations, all these risk prediction methods help identify individuals at high risk of CHD or CVD. By emphasizing the importance of considering risk factors and not treating them isolation, they help provide a better global assessment of CHD/CVD risk in view of reducing the global CVD/CHD risk of patients