Open AccessEvaluating New Cardiovascular Risk Factors for Risk Stratification
Author(s) -
Stern Ralph H.
Publication year - 2008
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/j.1751-7176.2008.07814.x
Subject(s) - medicine , risk stratification , stratification (seeds) , risk assessment , intensive care medicine , risk analysis (engineering) , environmental health , computer security , seed dormancy , botany , germination , dormancy , biology , computer science
thE JOUrNaL Of CLiNiCaL hypErtENsiON 485 there is an active debate on the best approach to evaluate new cardiovascular risk factors. the divergent views have been most clearly laid out in the case of C-reactive protein (Crp) and its incremental value over conventional cardiovascular risk factors. advocates of Crp argue that its addition improves global measures of fit,1 while others point out that it does not improve measures of discrimination.2,3 Discussions surrounding this debate have largely been technical, focusing on unique data sources and specific analytic approaches. the underlying principles, in contrast, have not been sufficiently highlighted. this paper presents a clinical perspective on the potential value of adding new cardiovascular risk factors to current methods for risk stratification. it proposes that novel risk factors should be evaluated by their effects on the population risk distribution curve, which presents the probability of occurrence of different levels of risk in a population as determined by a predictive model. Broader population risk distribution curves represent superior risk stratification. Last, it should be recognized that there are many correct ways to risk-stratify a population and that the best approach ultimately depends on the clinical goals.