Cardiovascular risk estimation - What is missing?

The review paper by Kevin Billups et al. (1) in this issue of the journal is set against a backdrop of the fact that cardiovascular disease (CVD) has become the world’s major cause of death. It was responsible for one-third of total global deaths in 2001, and the expectation is that by 2010 its continuing increase in incidence will result in it far exceeding all other causes of death and disability (2). Those of us living in developed countries have been facing this problem for many years. It is also clear that cardiovascular mortality is rising exponentially in developing countries, largely due to changes in lifestyle such as poor dietary habits and lack of exercise leading to obesity. Smoking prevalence is also high in these countries. Ethnic minorities in developed countries have been shown to be at increased risk for CVD (3,4).