Modern risk stratification in coronary heart disease

The prevalence and impact of cardiovascular diseases in the world are growing. There are 2 million deaths due to cardiovascular disease each year in the European Union; the main cause of death being the coronary heart disease responsible for 16% of deaths in men and 15% in women. Prevalence of cardiovascular disease in Romania is estimated at 7 million people, of which 2.8 million have ischemic heart disease. In this epidemiological context, risk stratification is required for individualization of therapeutic strategies for each patient. The continuing evolution of the diagnosis and treatment techniques combines personalized medicine with the trend of therapeutic management leveling, based on guidelines and consensus, which are in constant update. The guidelines used in clinical practice have involved risk stratification and identification of patient groups in whom the risk-benefit ratio of using new diagnostic and therapeutic techniques has a positive value. Presence of several risk factors may indicate a more important total risk than the presence / significant increase from normal values of a single risk factor. Modern trends in risk stratification of patients with coronary heart disease are polarized between the use of simple data versus complex scores, traditional data versus new risk factors, generally valid scores versus personalized scores, depending on patient characteristics, type of coronary artery disease, with impact on the suggested therapy. All known information and techniques can be integrated in a complex system of risk assessment. The current trend in risk assessment is to identify coronary artery disease in early forms, before clinical manifestation, and to guide therapy, particularly in patients with intermediate risk, which can be classified in another class of risk based on new obtained information. Abbreviations: ACS = acute coronary syndrome; AMI = acute myocardial infarction; BNP = brain natriuretic peptide; BP = blood pressure; BPs = systolic blood pressure; CHD= coronary heart disease; CRP = C-reactive protein; CX= circumflex artery; EF= ejection fraction; LAD= left anterior descendending coronary artery; LV = feft ventricle; MI= myocardial infarction; NGAL= neutrophil gelatinase associated lipocalin; NT-proBNP = N-terminal pro B-type natriuretic peptide; RCA= right coronary artery; RV= right ventricle