TITLE:
Improving Cardiovascular Risk Assessment to Optimize Therapy
AUTHORS:
Allen Adolphe, Shane Wilder, Teodor Duro, Robert Philip Eaton, David S. Schade
KEYWORDS:
Cardiovascular Disease, Atherosclerosis, Risk Equations, Apolipoprotein B, Lipoprotein(a), High Sensitivity C-Reactive Protein
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.13 No.1,
January
31,
2023
ABSTRACT: Background: Quantifying ten-year cardiovascular risk can be challenging. Different online risk calculators provide different risk estimates and online risk calculators use only one point in time. However, risk factors occur over the lifetime of the individual. Purpose: This manuscript provides three solutions to improving ten-year cardiovascular risk assessment in individuals at intermediate risk. Methods: Measuring Lipoprotein(a)—Lp(a) is recommendedfor assessing cardiovascular risk in all individuals who are in the intermediaterisk category by standard online risk calculators. Lp(a) is primarily determined by genetic inheritance. It has the undesirable properties of being proatherosclerotic, proinflammatory, and prothrombotic. Measuring apolipoprotein B (apo B) provides a good index of the number of atheroscleroticparticles present. Studies have demonstrated that small, dense LDL cholesterol particles are more atherogenic than larger, less dense LDL cholesterol particles. Measuring high sensitivity C-reactive protein (hsCRP) provides a good estimation of the degree of inflammation in the vascular system. Inflammation is a critical component of heart attacks and strokes. It is increased in diabetes and obesity. Treatment to reduce inflammation results in a reductionof cardiovascular events, independent of lipid values. Results: The above three risk factors should be measured in all patients with an intermediate risk score. Routine assays are readily available at a reasonable cost. They are independent risk factors for cardiovascular disease. Their recommendation is based on the pathophysiology of atherosclerotic cardiovascular disease. Successful therapy will result in the decrease of each of these risk factors. Conclusion: The recommended approach will improve the assessment of cardiovascular risk and guide the physician and patient to the correct treatment recommendations.