Calculating global risk: the key to intervention

The assessment of overall cardiovascular risk is a valuable and accepted means of identifying patients who are likely to benefit most from intervention to control individual cardiovascular risk. A straightforward and accurate means of calculating overall cardiovascular risk has been derived from the PROspective CArdiovascular Münster (PROCAM) Study, a large observational cohort study. The PROCAM risk calculator has several advantages over other risk calculators. For example, the algorithm derived from the Framingham study consistently and markedly overestimates the risk of myocardial infarction in the PROCAM population, or in a German cohort within the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Study, administered by the World Health Organization. In addition, the PROCAM risk calculator incorporates a broader range of commonly measured diagnostic parameters than the Framingham risk calculator. The multivariate Cox proportional hazards model that supports the PROCAM risk calculator has also provided valuable information on the principal driving forces behind atherosclerotic cardiovascular disease, with age, the level of LDL-cholesterol, smoking, the level of HDL-cholesterol, systolic blood pressure, family history of myocardial infarction, diagnosis of diabetes, and triglycerides all making significant contributions. As in other studies, low HDL-cholesterol emerged as a significant and independent risk factor for coronary disease, providing support for strategies aimed at correcting low HDL-cholesterol in addition to those aimed at reducing elevated levels of LDL-cholesterol.