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Cardiovascular risk assessment and primary prevention
In primary prevention the 10-year risk is calculated with a chart (SCORE2 in Europe and Israel) and the intensity of treatment follows it; someone who already has heart disease, diabetes with target-organ damage, kidney disease or familial hypercholesterolaemia does not need a chart — he is already at high risk.
Why it matters in the exam
The exam asks "which criteria are included in the SCORE chart?", for whom the LDL target is below 55, when aspirin for primary prevention is not recommended, and which "risk enhancer" can move an intermediate-risk patient to statin treatment. Other questions describe a patient with psoriasis or rheumatoid arthritis and ask about his risk.
The tested point: aspirin for primary prevention is not routine — the bleeding risk is close to the benefit — and over 60 it is not started at all according to the USPSTF.
The family doctor calculates the risk, explains it to the patient in simple numbers, and decides with him about a statin, the blood pressure target and lifestyle changes. An explanation such as "out of 100 people like you, 8 will fall ill in the next ten years" helps a shared decision. Further questions deal with adding a drug to a statin.
Key points
- Primary prevention — the SCORE2 chart for 10-year risk.
- Established disease, diabetes with organ damage or kidney disease — no chart, high risk.
- LDL targets: very high below 55, high below 70, moderate below 100.
- Aspirin in primary prevention — not routine; not started over 60.
- Risk enhancers and the calcium score decide at intermediate risk.
Summary table
| Risk level (ESC) | Who | LDL target | Exam note |
|---|---|---|---|
| Very high | Established cardiovascular disease; diabetes with target-organ damage; severe kidney disease; very high SCORE | Below 55 mg/dL and a 50% reduction | No chart needed |
| High | Familial hypercholesterolaemia; diabetes without target-organ damage of long duration; moderate kidney disease; a single extreme risk factor | Below 70 mg/dL | — |
| Moderate | By the chart | Below 100 mg/dL | Risk enhancers may decide |
| Low | By the chart | Below 116 mg/dL | Lifestyle |
| SCORE2 components | Age, sex, smoking, systolic blood pressure, non-HDL cholesterol | — | In the older SCORE chart — total cholesterol |
| Risk enhancers | Premature family history (male under 55, female under 65), high Lp(a), coronary artery calcium, inflammatory disease (psoriasis, RA), pre-eclampsia, early menopause | — | A calcium score of 0 sometimes allows a statin to be deferred |
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Sources
- European Society of Cardiology, 2021 — Guidelines on cardiovascular disease prevention in clinical practice (SCORE2 and SCORE2-OP)
- US Preventive Services Task Force, 2022 — Aspirin use to prevent cardiovascular disease; Statin use for the primary prevention of cardiovascular disease
- Israel Society for the Prevention of Heart Attacks and Strokes / Israel Heart Society, 2019–2023 — Israeli clinical guidelines for the treatment of dyslipidaemia and for the prevention of cardiovascular disease
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.