From Risk Markers to Preventive Action: A Proposed Semi-Quantitative Clinical Actionability Framework for Cardiometabolic Precision Prevention in Primary Care—A Narrative Review

Cardiometabolic prevention in primary care draws on a growing number of risk markers, yet a marker’s capacity to predict risk is often conflated with its capacity to change management. This narrative review proposes a semi-quantitative clinical actionability framework that takes the marker–context–action use case as its unit of appraisal and assigns ordinal scores (0–3) to seven domains: measurement readiness, prognostic validity, decision-relevant information, therapeutic linkage, clinical-utility evidence, harms and burden, and transportability and equity. Gating rules prevent prognostic strength alone from determining the tier. Applied by the authors to 19 use cases, the framework provisionally assigned five to Tier A (routine actionability): low-density lipoprotein cholesterol, blood pressure, type 2 diabetes detection, kidney function with albuminuria in diabetes or hypertension, and familial hypercholesterolaemia case-finding. Nine were assigned to Tier B (selective actionability), including the coronary artery calcium, apolipoprotein B, lipoprotein(a), natriuretic peptide and ankle–brachial index use cases, three to Tier C and two to Tier D. Most assignments depended on one-point differences in therapeutic linkage or clinical-utility scores. Tiers describe evaluated use cases, not intrinsic marker properties; the framework has not been validated. It implies that closing implementation gaps in Tier A use cases should generally precede the introduction of newer markers.