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Limiti degli algoritmi per la stima del rischio cardiovascolare

In una esaustiva revisione critica, Cooney e Coll affrontano il tema della stima del rischio cardiovascolare. Gli attuali mezzi per la stima appaiono utili, ma insufficienti e l'aggiunta dei fattori di rischio emergenti a quelli classici contemplati nella maggior parte degli algoritmi è troppo spesso irrilevante. Il problema della corretta classificazione, soprattutto per i soggetti a rischio intermedio rimane per il momento irrisolto e porta troppo spesso a sottostimare o a sovrastimare il rischio cardiovascolare reale con conseguenti errori nelle scelte terapeutiche.

Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians

Cooney MT, Dudina AL, Graham IM.

J Am Coll Cardiol 2009;54:1209-27

Atherosclerotic cardiovascular diseases (CVDs) are the biggest causes of death worldwide. In most people, CVD is the product of a number of causal risk factors. Several seemingly modest risk factors may, in combination, result in a much higher risk than an impressively raised single factor. For this reason, risk estimation systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies. In this article, the performances of the major risk estimation systems are reviewed. Most perform usably well in populations that are similar to the one used to derive the system, and in other populations if calibrated to allow for different CVD mortality rates and different risk factor distributions. The effect of adding "new" risk factors to age, sex, smoking, lipid status, and blood pressure is usually small, but may help to appropriately reclassify some of those patients who are close to a treatment threshold to a more correct "treat/do not treat" category. Risk estimation in the young and old needs more research. Quantification of the hoped-for benefits of the multiple risk estimation approach in terms of improved outcomes is still needed. But, it is likely that the widespread use of such an approach will help to address the issues of both undertreatment and overtreatment.

J Am Coll Cardiol 2009;54:1209-27