Jorge A. Pérez-Coaguila, Cardiología y Medicina General, Centro Médico César Vallejo, Lima, Perú
Cardiovascular risk stratification guides primary prevention decisions, but the usefulness of risk scores depends on their performance in the populations in which they are applied. This narrative review examines the main prediction models and their relevance to Peru. It discusses the limitations of extrapolating international models and the need for local validation. The review also addresses clinical and biological risk modifiers, including lipoprotein(a), inflammation, family history, and reproductive factors. It further examines the contribution of imaging techniques to detecting subclinical atherosclerosis, as well as the value and limitations of coronary artery calcium scoring. An approach integrating risk estimation, clinical modifiers, and selective assessment of subclinical atherosclerosis is proposed to guide individualized preventive decisions in the Peruvian context.
Keywords: Cardiovascular diseases. Risk assessment. Primary prevention. Atherosclerosis. Coronary artery calcium. Peru.