In summary, Guckelberger and colleagues add valuable further evidence that aggressive, often premature CV disease is a serious problem in long term OLTx survivors. Large prospective studies with sufficient statistical power need to be organized to assess which patients are at the highest risk for CV events and therefore will benefit form aggressive medical intervention. The author's assertion that there are significant differences in the three gloval CV disease risk stratification algorithms studied is less certain, and the conclusion that PROCAM risk estimates are "required" in the setup of prospective intervention trials is not supported by their data. Since global risk assesment for CV disease entails examination of all available risk factors (16) we suggest that future prospective studies add newer reported risk factors to those previously established including serum high sensitivity C-reactive protein, fibrinogen, homocysteine, lipoprotein a (LPa) and apolipoproteins A1 and B.
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