Cardiovascular risk calculators: understanding differences and realising economic implications.

In recent years, the concept of "global cardiovascular risk assessment" has grown in interest for its role in primary prevention of cardiovascular diseases. Interventions for reducing the risk of relapse for persons with cardiovascular past history are well agreed-on. But for persons without such a history, the risk of a first attack varies greatly and this variability implies a range in the intensity of interventions. In several countries, guidelines for general practitioners have been diffused about pharmaceutical prescriptions in the different risk classes. In particular, in Italy, a governmental drug management commission has established that Statins, the most used cholesterol lowering medicines, can be refunded by the National Healthcare System only if they are prescribed to hyper-cholesterol patients with a global risk greater than 20%. The question is: how to calculate the risk? We performed a review of both the web and the literature and we found a lot of different "risk calculators". By means of a simulation study, we showed that these tools, when used for the same person, may lead to very different results. We estimated the economic impact of using one or another calculator.