The total risk approach to prevention of coronary heart disease

The conventional risk factor approach to primary prevention excludes many patients who could benefit from preventive therapies. A total risk approach allows more accurate estimates of risk to guide clinical primary prevention efforts. Total risk of coronary heart disease is a calculation of the absolute risk of having a coronary heart disease (CHD) event (e.g., death, myocardial infarction) over a specified period. It is based on an empiric equation that combines major risk factors, such as blood pressure and cholesterol levels. Risk assessment tools can be a useful addition to the physician’s armamentarium. Physicians should find a method that works within their practice and should use it consistently to reduce risk and monitor their patients’ progress. In addition, physicians should actively encourage their patients to become better informed and more willing to cooperate in the proactive management of their health, particularly through adherence to positive lifestyle modifica¬tions and proven therapeutic interventions. Risk assessment tools represent only the beginning of preventive efforts and will never replace an engaged patient and a physician’s clinical experience. Several cardiovascular risk assessment tools are used in clinical practice worldwide. Amongst these, the WHO/ISH risk prediction charts specific for the WHO Region of South-East Asia, subregion D would be an appropriate tool to evaluate risk in Indian patients. nIntroduction Given the growing prevalence of Coronary Heart Disease (CHD), risk assessment and reduction remain fundamental to a physician’s medicine practice. Risk assessment in Cardiovascular Disease (CVD) is a constantly evolving field. The literature can be overwhelming; more than 4300 papers on the topic of CHD and risk were published in 2008 alone. Staying current with new, important developments in CVD risk assessment clearly is challenging for most 1 physicians. Clinical evaluation of CVD risk in patients with hypertension is evolving from independently assessing well-known, traditional risk factors (e.g. hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking) towards an integrated, multidisciplinary clinical approach, aimed at determining the global (or total) CVD risk profile in each individual patient for planning early and effective 2 strategies for cardiovascular prevention A paradigmatic example is provided by hypertension, in which new clinical behavior implies a shift from focusing only on high blood pressure levels towards a more integrated approach, aimed at identifying and reducing global CVD risk, as is 2 highlighted in the European Guidelines The first step in reaching primary prevention goals is to determine each individual patient's 10-year risk of CHD (probability of an individual’s experiencing an event over 10 years). Risk assessment instruments traditionally have viewed Low-Density Lipoprotein Cholesterol (LDL-C) levels as a cornerstone of individual risk and a principal target for therapeutic intervention. Although risk assessment tools are helpful, many may not be useful to physicians because they may be cumbersome, may measure individual risk components rather than global risk, and may require excessive time to complete. .