Can we improve cardiovascular risk prediction beyond risk equations in the physician's office?
OBJECTIVE
Beyond a global estimation of the cardiovascular risk through the assessment of major risk factors and their integration in dedicated risk scales or equations, the use of specific markers provides additive prognostic information at an individual level, including predisposing factors, which are not included in the risk equations as well as the individual susceptibility to their long-term exposure. However, the majority of these markers require specific devices and skills, which are not widely available in primary care.


METHODS
Some clinical and/or "low-cost" parameters are shown to be valuable risk markers, and their use could refine the risk estimation in a physician's office. Several epidemiologic studies suggest the heart rate, the pulse pressure and the ankle-brachial index are effective cardiovascular risk markers. The arms systolic pressure asymmetry could also be a useful marker of risk.


CONCLUSIONS
Through a general review, the authors evaluate the potential of these clinical markers, including their use in combination for more accurate risk determination.
Aboyans
Victor
V
Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France. vaboyans@ucsd.edu
Criqui
Michael H
MH
D000842:Ankle / Q000098:blood supply; D001132:Arm / Q000098:blood supply; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007866:Leg / Q000098:blood supply; D011379:Prognosis; D012307:Risk Factors