Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.
Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.
Romanens
Michel
M
Cantonal Hospital bVascular Risk Foundation, Olten, Switzerland.
Ackermann
Franz
F
Spence
John David
JD
Darioli
Roger
R
Rodondi
Nicolas
N
Corti
Roberto
R
Noll
Georg
G
Schwenkglenks
Matthias
M
Pencina
Michael
M
D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology; D008076:Cholesterol, HDL / Q000097:blood; D003362:Cost-Benefit Analysis; D016002:Discriminant Analysis; D050171:Dyslipidemias / Q000097:blood / Q000150:complications; D019317:Evidence-Based Medicine; D006305:Health Status Indicators; D006801:Humans; D016013:Likelihood Functions; D015233:Models, Statistical; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D008076:Cholesterol, HDL