Risk Scores for Acute Vascular Events: Expectations and Limitations

Cardiovascular disease (CVD) is a major global health burden, despite declines in the mortality rate due to CVD in highincome and some middle-income countries, according to a study published in the Journal of American College of Cardiology (May 2017). The leading cause of healthcare related loss worldwide and in each region of the world is ischemic heart disease. Seventy years of dedicated research under the leadership of the National Institutes of Health and Boston University by the pioneering researchers of the now famous Framingham Heart Study, has provided a wealth of knowledge on the modifiable risk factor functions. One of the great contributions of FHS is that early work by this group opened up and supported the whole field of preventive cardiology by identifying modifiable risk factors for heart disease. Identification of these risk factors also raised the expectations of public in terms of possible reduction or reversal or prevention of this disease by the optimal management of these observed risks. In view of the fact, this was a one of a kind study that received the support of NIH for the longest time, generated more than 3000 articles; expectations of policy makers as well as general public have consistently remained high. Public health policies that were developed based on these findings have contributed significantly to the reduction in smoking, blood pressure, lowering of elevated levels of cholesterol and triglycerides. Considering the twin epidemics of obesity and type-2 diabetes, which are out of control worldwide, what we have gained in the management of modifiable risks may be lost, if the present trend in the increase of obesity and diabetes are not brought into control. Based on the results of FHS a Risk Score calculator has been developed. Development of new biomarkers, and new diagnostic imaging techniques, have provided additional data points for fine tuning the risk stratification for the development of the cardiovascular disease as well as for acute vascular events. In this brief overview, we have discussed some salient points and expressed our viewpoint on this topic of great public health importance.