[Which cardiovascular risk tables should we use?].

Predicting someone’s chances of experiencing a cardiovascular event is a medical challenge that has yet to be resolved.1 Large-scale epidemiologic observation studies enable us to identify variables associated with greater probability of presenting cardiovascular disease. The INTERHEART study has recently corroborated these, comparing the circumstances that differentiated patients with myocardial infarction from those in a healthy control group.2 The results facilitated the definition of 9 variables to which we can attribute 90% of the risk of presenting infarction. Smoking, dyslipidemia, diabetes, hypertension, obesity, and stress were, once again, the decisive factors, whereas consumption of fruit and vegetables, physical activity, and the consumption of alcohol protected patients from the process. These were the variables independently of age, gender, or geographical location. The tables and formulae used to calculate patient cardiovascular risk include most, but not all, of these factors as variables. Thus, conditions with an apparently clear association with vascular risk, like obesity, do not generate additional information. In the last decade, newlydefined, clinical and biochemical parameters have been associated with inflammation or thrombogenesis and are related with vascular risk. However, when used to improve the sensitivity and specificity of parameters based on classical factors, they do not contribute to significant improvement. In a recent study, the incorporation of as many as 10 biochemical parameters into classical risk factors to calculate cardiovascular risk did not improve the sensitivity or specificity of the classical formulae.3 The Reynolds Score,4 a new coefficient to calculate vascular risk for women, has recently been published. It incorporates ultrasensitive CRP data and family history of early cardiovascular disease, and clearly improved the predictive value of the Framingham algorithm. Which Cardiovascular Risk Tables Should We Use?