The concept of global risk

Classically, strategies for the prevention of CHD have been divided into primary and secondary approaches. Primary prevention refers to measures taken before clinically manifest atherosclerosis appears, while secondary prevention refers to measures taken after its appearance. Recent years have seen a shift in emphasis from preventive strategies based on this classic division to one based on overall or global risk, which is usually expressed in terms of the percentage chance, on average, of suffering a cardiovascular event such as MI, sudden coronary death or stroke within a given period, usually 10 years.

This concept of global risk has the following important implications:

• Many persons with no signs or symptoms of atherosclerosis but with a number of risk factors have a risk of MI as high as that of persons with established CHD.
• Moderate reduction in a number of risk factors usually achieves more than a large reduction in a single risk factor. Treatment should therefore be aimed at reducing overall risk rather than one particular risk factor.
• Dyslipidemic patients frequently remain at high residual vascular risk despite treatment in accordance with current standards of care. Multifactorial intervention involving combination therapy targeting all lipid goals, intensive control of blood pressure and glycemia, and lifestyle modification as the optimal approach to reducing residual vascular risk in dyslipidemic patients is recommended. Ongoing outcomes studies, i.e., ACCORD, AIM-HIGH and HPS2-THRIVE, will provide important information about the risk and benefit of combination therapy.
  

Several scoring schemes like the PROCAM Risk Scores exist for calculating global risk of MI.