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Almanac 2012: cardiovascular risk scores. The national society journals present selected research that has driven recent advances in clinical cardiology
  1. Jill P Pell
  1. Correspondence to Jill P Pell, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK; jill.pell{at}glasgow.ac.uk

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Global risk scores use individual level information on non-modifiable risk factors (such as age, sex, ethnicity and family history) and modifiable risk factors (such as smoking status and blood pressure) to predict an individual's absolute risk of an adverse event over a specified period of time in the future. Cardiovascular risk scores have two major uses in practice. First, they can be used to dichotomise people into a group whose baseline risk, and therefore potential absolute benefit, is sufficiently high to justify the costs and risks associated with an intervention (whether treatment or prevention) and a group with a lower absolute risk to whom the intervention is usually denied. Second, they can be used to assess the effectiveness of an intervention (such as smoking cessation or antihypertensive treatment) at reducing an individual's risk of future adverse events. In this context, they can be helpful in informing patients, motivating them to change their lifestyle, and reinforcing the importance of continued compliance.

How have risk scores evolved?

Our understanding of how best to measure and respond to risk has evolved over a number of years. Historically, individual risk factors were measured and managed in isolation, but this has been replaced by the adoption of global risk scores that calculate overall risk based on a range of risk factors. Also, the opportunistic use of risk scores among people who present to healthcare workers has been replaced by increased use of either mass screening or targeted screening of at-risk populations in an effort to identify unmet need and reduce health inequalities. The integration of risk calculators into administrative software packages and on-line access have made risk scores readily accessible to all general practitioners in the UK.1 The scope of risk scores has recently widened beyond coronary heart disease to other conditions, such as heart failure and diabetes mellitus. …

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