Assessment of Cardiovascular Risk: A Return to Basics

Medicine (in particular cardiovascular medicine) has become increasingly dependent on sophisticated technology for the diagnosis and treatment of disease. The broad application of such technology has taken place in the absence of rigorous risk- and cost–benefit analysis. Further, the characterization of cardiovascular risk has focused on the minority of patients with clinically advanced disease. The ability to predict the likelihood of development of serious disease depends on the complete and accurate characterization of risk factors. That the presence of such factors may be revealed in the clinical and historical information obtained from a patient during the initial encounter with a physician is explored by Pryor and colleagues in this issue of Annals. The quantitative importance of this easily obtained information is expressed in a composite probability that is in accord with observed outcomes. In some instances, such information may provide a more useful prediction scheme than costly technologic means. Thus, a return to the fundamentals of clinical medicine represents an “advance” in the quest for appropriate allocation of resources.

The ability to predict which patient will obtain maximum benefit from treatment depends not only on the inherent potential of the treatment but also on the underlying risk of the disease. Given the current plethora of diagnostic and therapeutic options in cardiovascular medicine, an accurate assessment of the risk for cardiovascular death or major illness is vital. In this issue of Annals, Pryor and coworkers [1] develop a cogent argument for the application of first principles—history taking, physical examination, and routine laboratory information—to the stratification of risk …