Atherosclerotic cardiovascular disease risk prediction: current state-of-the-art

Early detection of ASCVD remains essential and cost-effective to reduce ASCVD morbidity and mortality. Various risk assessment tools are used in different parts of the world based on regional guidelines. Risk assessment tools are constructed from a process that involves gaining important risk variables from derivation cohorts, studying their discrimination and net reclassification parameters, and employing validation techniques to ascertain their predictive utility; each tool has advantages and limitations, as discussed above. ASCVD risk assessment by demographic and conventional risk factors-based approach remains simple to use in the clinic and is the first line of assessment. However, this ‘one-size-fits-all’ approach has limitations in the 21st century. In the future, individualised risk assessment using coronary calcium and ultrasoundbased peripheral arterial plaque measurements, PRS, biomarkers, artificial intelligence and big data using vast amounts of data from various databases such as the UK Biobank, SWEDEHEART, EuroHeart and similar population databases, and a multiomics personalised approach will likely be used. Lastly, an important goal will be to expand to the prediction not just of ASCVD but also of other cardiac conditions such as atrial fibrillation, HF, CKD, etc. © 2023 BMJ Publishing Group. All rights reserved.