Identifying Patients at High Risk of a Cardiovascular Event in the Near Future

The National Heart, Lung, and Blood Institute convened a working group to provide basic and clinical research recommendations to the National Heart, Lung, and Blood Institute on the development of an integrated approach for identifying those individuals who are at high risk for a cardiovascular event such as acute coronary syndromes (ACS) or sudden cardiac death in the “near term.” The working group members defined near-term as occurring within 1 year of the time of assessment. The participants reviewed current clinical cardiology practices for risk assessment and state-of-the-science techniques in several areas, including biomarkers, proteomics, genetics, psychosocial factors, imaging, coagulation, and vascular and myocardial susceptibility. This report presents highlights of these reviews and a summary of suggested research directions. Near-Term RiskThe proper deployment of preventive strategies requires an accurate classification system that allows the physician to target intensive treatments to the highest-risk patients. A commonly recommended approach is a multivariable assessment such as the Framingham Risk Score (FRS).1 Although the FRS is recommended in many guidelines on cardiovascular risk assessment,2 it has some limitations. It does not include several factors of the metabolic syndrome (glucose intolerance, central obesity, and hypertriglyceridemia), nor does it include family history. Moreover, the FRS classifies risk over a period of 10 years rather than in the near term (within 1 year). Indeed, no algorithm has been developed that accurately predicts near-term risk across diverse populations.The ability to forecast near-term risk of ACS or sudden cardiac death would represent an important advance in cardiovascular medicine because it would clarify which individuals are in most urgent need of intervention. It would help identify those rare asymptomatic, apparently healthy individuals who are in imminent danger of a cardiovascular event yet ordinarily would not receive therapy at all. In asymptomatic individuals judged to be at intermediate or …