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Cardiovascular risk assessment beyond Systemic Coronary Risk Estimation: a role for organ damage markers

Volpe, Massimoa,b; Battistoni, Allegrab; Tocci, Giulianob; Rosei, Enrico Agabitic; Catapano, Alberico L.d; Coppo, Rosannae; del Prato, Stefanof; Gentile, Sandrog; Mannarino, Elmoh; Novo, Salvatorei; Prisco, Domenicoj; Mancia, Giuseppek

doi: 10.1097/HJH.0b013e3283525715

Background: Cardiovascular risk assessment in the clinical practice is mostly based on risk charts, such as Framingham risk score and Systemic Coronary Risk Estimation (SCORE). These enable clinicians to estimate the impact of cardiovascular risk factors and assess individual cardiovascular risk profile. Risk charts, however, do not take into account subclinical organ damage, which exerts independent influence on risk and may amplify the estimated risk profile. Inclusion of organ damage markers in the assessment may thus contribute to improve this process.

Objective: Our aim was to evaluate the influence of implementation of SCORE charts with widely available indexes of organ damage, with the purpose to ameliorate individual risk assessment.

Methodology: We searched for evidence about the predictive value of left ventricular hypertrophy (LVH), estimated glomerular filtration rate (eGFR), microalbuminuria (MAU) and metabolic syndrome on different risk profiles estimated by SCORE. Interventional and observational trials including at least 200 patients and published after 2000 were selected.

Results: The presence of organ damage as well as the number of abnormal parameters indicating organ damage is associated with increased cardiovascular risk, independently of SCORE. In the area of high risk, the impact of different markers of organ damage is heterogeneous. Combined risk models of SCORE and subclinical organ damage have major impact on risk stratification and may impact on recommendation in primary prevention in all SCORE categories.

Conclusion: Available evidence suggests a tangible clinical advantage of adding the evaluation of simple organ damage markers to risk charts in cardiovascular risk prediction.

aCardiology Department of Clinical and Molecular Medicine, University of Rome ‘Sapienza’, Sant’Andrea Hospital, Rome

bIRCCS Neuromed, Pozzilli

cDepartment of Medical and Surgical Sciences, University of Brescia, SpedaliCivili, Brescia

dDepartment of Pharmacological Sciences, University of Milan, Milan

eDepartment of Nephrology, University of Turin, Regina Margherita Children Hospital, Turin

fDepartment of Endocrinology and Metabolism, Orthopedics and Traumatology, Occupational Medicine, University of Pisa, Pisa

gDepartment of Clinical and Experimental Medicine, Second University of Naples, Naples

hDepartment of Internal Medicine, University of Perugia, Perugia

iDepartment of Cardiology, University of Palermo, Palermo

jDepartment of Medical and Surgical Critical Care, University of Florence, Florence

kDepartment of Clinical Medicine, University Milan-Bicocca, San Gerardo Hospital, Monza, Italy

Correspondence to Professor Massimo Volpe, MD, FAHA, FESC, Chair and Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome ‘Sapienza’, Sant’Andrea Hospital, Via di Grottarossa 1035-9, 00189 Rome, Italy. Tel: +39 06 3377 5654; fax: +39 06 3377 5061; e-mail:

Abbreviations: ACR, albumin/creatinine ratio; CKD, chronic kidney disease; CKD-EPI, chronic kidney disease epidemiology collaboration; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; HDL, high-density lipoprotein; LVH, left ventricular hypertrophy; MAU, microalbuminuria; MDRD, modification of diet in renal disease; MetS, metabolic syndrome; MI, myocardial infarction; PRISMA, preferred reporting items for systematic review and meta-analysis; SCORE, Systemic Coronary Risk Estimation; TOD, target organ damage; UACR, urinary albumin/creatinine ratio

Received 22 July, 2011

Revised 21 November, 2011

Accepted 8 February, 2012

© 2012 Lippincott Williams & Wilkins, Inc.