A number of scoring systems can give an estimated risk of cardiovascular events occurring in a given time frame (often 10 years), most importantly for Heart Attack and Stroke. However there are two principle problems with all scoring systems:
Firstly they can’t tell you for sure what will happen to a given individual with and without treatment (though they do give us our ‘best estimate’ on which to base decision making).
Secondly they don’t tell us what level of risk is ‘acceptable’ that is to say the level at which we should change our lifestyle or take tablet treatment. Governments, National and International societies and other advisory bodies give us guidelines however these are sometimes based on financial and logistical considerations as well as simply what is best for the individual. Ultimately scoring systems simply provide a guide and a mutually agreeable plan needs to be made for each individual.
Screening for cardiovascular disease in people who have never had a cardiovascular event has two key elements:
firstly looking at risk factors (principally smoking, diabetes, high blood pressure, family history) and secondly looking for evidence of subclinical (that which you are not aware of) cardiovascular disease. Evidence of subclinical disease can be sought with a number of tests such as ECG, Holter Monitor, Exercise Test, Cardiac Ultrasound (Echo), Cardiac CT and Carotid Intima Media Thickness (IMT).
It is fairly straightforward to assess the main risk factors for cardiovascular disease with a clinical review and blood test. This is cheap, effective and can give a good guide to future risk and what action if any is necessary. Risk calculations can be further improved and refined by adding in other factors and seeking evidence of subclinical disease. More focused individually ‘personalised’ tailored preventive strategies are the subject of ongoing research.
The appropriateness of screening tests and the interpretation of the results depends on the individual in question, including the age and the likely cardiovascular risk. Decisions on interpretation of clinical results and any management steps should be made in consultation with your doctor so that a mutually agreeable management plan may be reached.