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RESEARCH PRODUCT

Coronary artery disease: seeing or foreseeing?

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This editorial refers to ‘Discordance between Framingham Risk Score and atherosclerotic plaque burden’, by A. Pen et al., doi:10.1093/eurheartj/ehs473 The prevention of cardiovascular disease (CVD) has been a major priority and challenge for policy-makers and healthcare workers for at least five decades. In this ‘co-ordinated set of actions, at public and individual level, aimed at eradicating, eliminating, or minimizing the impact of CVDs and their related disability’,1 the capacity to predict the presence of coronary atherosclerosis obviously plays a central role. Studies show that the combination of a few major risk factors is an easily accessible proxy for risk stratification: the European Society of Cardiology (ESC) EUROSCORE tables use sex, smoking, blood pressure, diabetes, blood cholesterol levels, and nationality (high- vs. low-risk countries, or nation-specific charts) to provide direct and intuitively useful information on the risk of individuals belonging to specific risk strata. Under the guidance of these epidemiological data, a set of interventions aimed at the prevention of cardiovascular disease can be developed: as the 2012 ESC guidelines emphasize,1 such efforts are a life-long commitment for both patients (or healthy individuals) and healthcare workers: CVD prevention ideally starts before birth and lasts until the end of life. At a population level, governments and scientific societies have been proming for >50 years ad hoc policies and community interventions aimed at reducing the incidence and consequences of CVD through lifestyle and environmental changes targeted at the population at large. Examples of these policies include smoking bans, awareness campaigns on the importance of high blood pressure, CVD in women, or ‘heart days’, where the population is offered the possibility to undergo a free cardiovascular check-up.2–4 These interventions appear to be at least as effective in reducing cardiovascular mortality as the improvements in medical technologies and drug development. …