Are We There Yet?
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Articles, see p 1419 and p 1430
Population aging and improvements in survival after cardiovascular disease have contributed to worldwide increases in the number of patients with established cardiovascular disease. An almost epidemic number of people, >16 million Americans, suffering from ischemic heart disease serves as clear evidence of the importance of ischemic heart disease.1 Despite a decline in mortality, ischemic heart disease is now the leading cause of death worldwide, which according to estimates from the World Health Organization, will rise to 11.1 million cardiovascular deaths by 2020.2
The assessment of cardiovascular disease risk and the prevention of recurrent events in patients suffering from cardiovascular disease represent an opportunity for major public health gains.3 Informal methods of risk prediction have traditionally been used to guide which individuals may benefit from therapy.4 However, due to variation in the observed and unobserved risk factors and the fact that clinicians are not good at estimating the likelihood of an outcome, risk assessment based on informal methods is not optimal.5,6 Multivariable risk models in the setting of primary prevention have been intensely studied, in contrast to patients with established cardiovascular disease, where much less data are available.4
In this issue of Circulation, Kaasenbrood and colleagues7 have presented their findings regarding the 10-year risk of recurrent vascular disease events in a population with different manifestations of cardiovascular disease. The SMART risk score (Second Manifestations of Arterial disease) for 10-year …