Cardiovascular Disease Risk Assessment: Review of Established and Newer Modalities.

OPINION STATEMENT: Cardiovascular disease (CVD) risk assessment has changed substantially in recent years. Statins are recommended for a larger proportion of Americans based on a recently recommended CVD global risk calculator derived from studies of multiple large, diverse, community-based cohorts. Recent research shows that patients that are intermediate risk for CVD events may benefit from net reclassification of risk based on circulatory biomarkers like c-reactive protein, interleukin-6, lipoprotein(a), and lipoprotein-associated phospholipase A2. In addition, multiple imaging biomarker modalities, including coronary artery calcium and carotid intima-media thickness, may play an important role in further risk stratification for patients in the later stages of CVD development. The data obtained from these markers could play an important role for deciding how aggressive a physician should be with pharmacological therapy. Here, we discuss many of the current recommendations of CVD risk assessment including those included and excluded from recent guidelines, while addressing the most recent data supporting renewed and newer modalities for CVD risk assessment.