Risk estimation for the primary prevention of cardiovascular disease: considerations for appropriate risk prediction model selection

Abstract

Cardiovascular diseases remain the number one cause of death globally. Cardiovascular disease risk scores are an integral tool in primary prevention, being used to identify individuals at the highest risk and guide the assignment of preventive interventions. Available risk scores differ substantially in terms of the population sample data sources used for their derivation and, consequently, in the absolute risks they assign to individuals. Differences in cardiovascular disease epidemiology between the populations contributing to the development of risk scores, and the target populations in which they are applied, can result in overestimation or underestimation of cardiovascular disease risks for individuals, and poorly informed clinical decisions. Given the wide plethora of cardiovascular disease risk scores available, identification of an appropriate risk score for a target population can be challenging. This Review provides an up-to-date overview of guideline-recommended cardiovascular disease risk scores from global, regional, and national contexts, evaluates their comparative characteristics and qualities, and provides guidance on selection of an appropriate risk score.

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Steps to determine if a candidate cardiovascular disease risk prediction model is appropriate for a given population of interest Where more than one candidate CVD risk model is deemed appropriate for use in a population, preference should be given to any score that is recommended by national or international guidelines and used in accordance with guideline recommendations. *Reflecting current cardiovascular disease incidence rates and epidemiological trends in the population; target populations with rapidly changing cardiovascular disease rates will need more frequent updates (for example every 5 to 10 years).