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Is it time for a new approach in cardiovascular risk assessment?

Prospective epidemiologic studies have established risk factors for atherosclerotic cardiovascular diseases, including: advanced age, smoking, obesity, diabetes or glucose intolerance, elevated blood lipids, hypertension and sedentary life habits. Many of these factors are closely related to modern lifestyles and can be modified. They have been used for the risk estimation and the planning of preventive measures (1, 2). In addition to the commonly used classic risk factors, there is evidence suggesting the existence of novel risk factors, including: inflammation, chronic latent infections e.g. cytomegalovirus or Helicobacter pylori infection, hypercoagulability, impaired fibrinolysis, increased platelet reactivity, enhanced oxydative stress, elevated blood homocysteine levels and lipoprotein particles such as lipoprotein (a) and small dense lowdensity lipoprotein cholesterol (3). Depression and complex socioeconomic factors have also been recognized as factors strongly influencing the prognosis in cardiovascular diseases (3, 4). These novel factors might be useful in stratifying cardiovascular disease severity and prognosis more accurately. This may be important especially in cases free of conventional risk factors, as it has been shown that up to one third of first coronary events occur among individuals without conventional risk factors (5). In addition, the same risk factors may not have the same causal effect in different ethnic and population groups (6). Moreover, there is an awareness of the fact that risk factors tend to appear in a cluster, linked to each other. For example, the metabolic or insulin resistance syndrome has been identified on the basis of the clustering of multiple cardiovascular risk factors (7). Similarly, endstage renal disease has been recognized as a multirisk condition, characterized by an unexpectedly high prevalence of cardiovascular diseases (8). Taking all these into consideration, it is not surprising that the preparation of cardiovascular risk estimation tables and guidelines becomes more and more difficult (9). Two opposite, but also complementary claims can be observed: a need for a more comprehensive and, at the same time, a more individually based approach in cardiovascular risk assessment. In particular, the problem is how to interpret the results of the basic research and clinical and epidemiologic studies to be specifically oriented towards conditions of an individual. Evidence from many fields of research indicates that it is time for a new approach in cardiovascular disease research and risk assessment.

cardiovascular risk assessment ; new approach ; systems biology ; bioinformatics

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