title: [Old and new scoring systems for assessing cardiovascular risks: problems with the validity, the precision and the homogenicity of the risk categories].
abstract: Scoring systems for cardiovascular-risk assessment are increasingly being used to identify patients suitable for primary prevention measures. However, the quality of risk-score systems is threatened by (a) external invalidity, which can be partly compensated for by calibration of the score, (b) risk-score model imprecision, reflected by wide confidence intervals for the risk estimate, and (c) risk-category heterogeneity resulting from the random spread of known and unknown risk factors that are unaccounted for in the scoring system. The commonly used Framingham risk score is limited by imprecision and marked risk-category heterogeneity. The recently published SCORE risk model is probably more precise, but lacks homogenous risk categories. To prevent large scale undertreatment of patients at high cardiovascular risk, the commonly used risk threshold for initiating primary preventative treatment should be lowered.
authors.affiliation: Afd. Inwendige Geneeskunde, VU Medisch Centrum, De Boelelaan 1117, 1081 HV Amsterdam. y.smulders@vumc.nl
authors.forename: Y M
authors.initials: YM
authors.lastname: Smulders
authors.forename: A M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: P J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity