Multivariable cardiovascular risk-assessment instrument in action

Two 42-year-old men with a serum cholesterol level of 225 mg/dL presented to our institution. The first patient (case 1) had diabetes, was a smoker, and had a high-density lipoprotein (HDL) cholesterol level of 39 mg/dL and a systolic blood pressure of 145 mm Hg. The second patient (case 2) did not have diabetes, was not a smoker, and had an HDL cholesterol level of 55 mg/dL and a systolic blood pressure of 124 mm Hg.

Although both patients had the same elevated serum cholesterol level, their estimated cardiovascular disease (CVD) risk was quite different (Table). Because the patient in case 2 demonstrated isolated hypercholesterolemia, his CVD risk was low. In contrast, the patient in case 1 had multiple coexisting elevated risk factors, as is often the case; thus, his CVD risk was about 6-fold higher, mandating correction of other risk factors as well as more intensive treatment of his dyslipidemia.

The National Cholesterol Guidelines link treatment thresholds and goals to global CVD risk. Our multivariable CVD risk-assessment model estimates probability of disease, allowing the intensity of risk factor management to match a patient’s CVD risk, ensuring treatment is most cost-effective. Serial assessment of global CVD risk also can be used to monitor a patient’s response to treatment and other preventive measures, and any progress would be reflected by improvements in the patient’s multivariable risk score. Finally, this multivariable assessment model also enables physicians to avoid overlooking high-risk CVD candidates who have multiple marginal risk factors while avoiding needlessly alarming patients who have only 1 isolated risk factor.