Cardiovascular disease risk assessment and prevention: current guidelines and limitations.

Even after decades of progress in understanding atherosclerotic cardiovascular disease (ASCVD) and improved cardiovascular event prevention, the incidence, consequences and cost of cardiovascular disease (CVD) remain a significant public health issue. Observational studies have identified major ASCVD risk factors and lead to the development of a number of risk assessment systems/scores now in use. However many patients who will develop clinically important CVD are not identified by current systems or approaches and significant numbers of recurrent cardiovascular events continue to occur even after aggressive secondary prevention treatment strategies are utilized. Some now term this residual risk. The statin era revolutionized clinical practice with effective outcome-driven risk reduction. As a result there are now numerous clinical recommendations or guidelines for ASCVD risk stratification and treatment. Further disease and event prevention may rely on improved patient-centered risk stratification using novel biomarkers, imaging techniques, and new treatment approaches including emerging pharmacologic therapies.