There are two almost insuperable barriers to providing a precise and confident estimation of risk for any individual except, possibly, under special circumstances.
The two barriers are:
the enormous number of potential risk factors, most of them unknown
the fact that the risks are not additive
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What this means in practice is that there are literally hundreds of different proteins directly involved in the physiological processes which influence the development of coronary artery disease (CAD).
Each of these is under some sort of genetic and environmental influence - generally both - which either causes or prevents atherosclerosis, subsequent clinical events or both.
Then there is the fact that we cannot simply add up risk, even if it were possible to determine many of the individual risk factors in a single person. This is because risk varies depending on what other risk factors are present and how severe they are.
At best, experts can provide approximate scores for a small number of the best established risk factors. The assumption is that as the severity or number of each risk factor increases, then so does the risk.
This leads us to guidelines for primary prevention of CAD which take into account this inherent uncertainty but provide relatively simple rules for the introduction of different forms of treatment.
Primary prevention, to which published risk scores largely relate, refers to prevention of the disease in the first place. Secondary prevention is regarded as modifying risk factors once disease is known to be present, so as to prevent progression of the disease.
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