Primary prevention of coronary artery disease. Is there a role for risk scores?

Primary prevention of coronary artery disease is becoming increasingly important due to treatment costs. The assessment of overall cardiovascular risk in Germany is usually performed using the PROCAM algorithm or the ESC score. If the 10-year risk of myocardial infarction or cardiovascular death exceeds 20% or 5%, respectively, intensive risk intervention is cost effective and the number needed to treat (NNT) is usually < 200. An NNT of < 200 can also be achieved by treating a single pronounced risk factor. The CARRISMA system uses lifestyle factors in addition to conventional factors to improve risk stratification and also supports lifestyle modification. During the last two decades average life expectancy has increased by 6 years and possibilities for prevention have improved. Risk stratification for prevention should therefore be offered up to the age of 70, as in the Framingham risk score. Risk scores support evidence-based and cost-effective prevention even in higher age groups.