CVD in Europe CVD in Europe: How do I assess risk and what’s new?

Mortality from ischaemic heart disease has fallen over the past two decades but remains the leading cause of death across Europe. The risk equations in common use such as Framingham are based on data from the 1980s. Many risk equations can under or over predict the risk of cardiovascular disease in some subgroups. The need for better risk assessment has never been greater but a plethora of biomarkers available can be a source of confusion for many clinicians. ‘2010 has seen the rise of the new risk marker’ said Professor Terje Pedersen (Oslo, Norway). He went on to describe a European committee which has been set up to tackle this issue. ‘Does the marker add anything to existing risk prediction?’ is the key question the committee will hope to address for each new test. Professor Pedersen reviewed the evidence for a range of markers for cardiovascular disease (CVD). C reactive protein (CRP) has been widely investigated as a marker of CVD. A recent meta-analysis showed that CRP was similar to other risk factors in predicting CVD. Lp-PLA2 is bound to LDL cholesterol and propagates inflammation in plaques. It correlates well with CVD risk but does not add further information to existing risk calculators. Lp(a) has recently re-emerged as a risk factor as well as a risk marker for CVD. ‘Lp(a) remains a strong marker even when adjustment for other risk factors has been done’, said Professor Pedersen. The role of coronary calcium scores in predicting coronary heart disease in young females was also described. 

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