{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T05:02:30Z","timestamp":1784350950967,"version":"3.55.0"},"reference-count":99,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Cardiovascular disease (CVD) remains the leading cause of mortality across the European Union (EU), with a fourfold to fivefold east\u2013west gradient in standardized circulatory-disease mortality. Romania ranks second highest in the EU (787 per 100,000 inhabitants in 2023). Primary-prevention practice is organized around two quantitative frameworks\u2014the 2021 European Society of Cardiology (ESC) SCORE2\/SCORE2-OP system and the 2018\/2019 American College of Cardiology\/American Heart Association (ACC\/AHA) Pooled Cohort Equations (PCE)\u2014which converge on therapy but diverge on patient selection. Methods: We conducted a structured narrative review (SANRA-compliant) of contemporary primary-prevention guidelines, validation studies, key trials of risk-modifier interventions, and Romanian epidemiological data through April 2026. On this basis, we developed ROMA-CV (Risk Of Multifactorial Atherosclerosis\u2014CardioVascular) as a conceptual, country-specific risk-stratification framework anchored to existing Class I\/IIa recommendations or Level A\/B evidence, rather than as a fully developed, ready-to-use clinical tool Results: Four structural limitations of SCORE2 are clinically consequential in Romania: (i) an age floor of 40 years that excludes the population in which premature myocardial infarction is most preventable; (ii) a country-level calibration coefficient applied to individuals; (iii) permissive treatment of lipoprotein(a) [Lp(a)]; and (iv) an under-emphasis of subclinical-atherosclerosis imaging. We propose ROMA-CV (Risk Of Multifactorial Atherosclerosis\u2014Cardiovascular), a four-step algorithm retaining SCORE2 as the quantitative spine while embedding once-in-a-lifetime Lp(a) measurement, a mandatory amplifier checklist, and selective coronary artery calcium (CAC) or carotid\/femoral ultrasound imaging. Conclusions: ROMA-CV is a hypothesis-generating proposal that operationalizes existing evidence-based recommendations into a deterministic Romanian pathway aligned with the 2025\u20132030 Romanian National Plan for Non-Communicable Diseases and the EU Cardiovascular Health Plan. The algorithm is not a validated clinical decision tool and requires prospective external validation in Romanian cohorts\u2014alongside feasibility, cost-effectiveness, and implementation studies\u2014before any consideration of routine clinical adoption.<\/jats:p>","DOI":"10.3390\/jcm15145490","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:34:44Z","timestamp":1783996484000},"page":"5490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond SCORE2: Rethinking Cardiovascular Risk Assessment in a Very-High-Risk European Setting\u2014A Narrative Review and Proposal of the ROMA-CV Algorithm for Romania"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9003-456X","authenticated-orcid":false,"given":"Daniel Miron","family":"Brie","sequence":"first","affiliation":[{"name":"Cardiovascular Disease Institute Timisoara, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-9601","authenticated-orcid":false,"given":"Cristian","family":"Morno\u0219","sequence":"additional","affiliation":[{"name":"Cardiovascular Disease Institute Timisoara, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9387-1141","authenticated-orcid":false,"given":"Roxana","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Cell and Molecular Biology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Tudor Vladimirescu Street, No. 14, 300174 Timisoara, Romania"},{"name":"ANAPATMOL Research Center, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Tudor Vladimirescu Street, No. 14, 300174 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4078-1537","authenticated-orcid":false,"given":"Alina Didu\u021ba","family":"Brie","sequence":"additional","affiliation":[{"name":"Department of Cell and Molecular Biology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Tudor Vladimirescu Street, No. 14, 300174 Timisoara, Romania"},{"name":"ANAPATMOL Research Center, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Tudor Vladimirescu Street, No. 14, 300174 Timisoara, Romania"},{"name":"\u201cLouis \u021aurcanu\u201d Emergency Children Hospital, Doctor Iosif Nemoianu Street, No. 2, 300011 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","unstructured":"Eurostat (2026, May 03). 33% of Deaths Caused by Circulatory Diseases in 2023. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/products-eurostat-news\/w\/ddn-20260313-1."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1093\/eurheartj\/ehab892","article-title":"European Society of Cardiology: Cardiovascular disease statistics 2022","volume":"43","author":"Timmis","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S0140-6736(19)32008-2","article-title":"Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-, middle-, and low-income countries (PURE): A prospective cohort study","volume":"395","author":"Yusuf","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC)","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_6","first-page":"e596","article-title":"2019 ACC\/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"140","author":"Arnett","year":"2019","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e285","DOI":"10.1016\/j.jacc.2018.11.003","article-title":"2018 AHA\/ACC\/Multisociety Guideline on the Management of Blood Cholesterol","volume":"73","author":"Grundy","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","first-page":"e1338","article-title":"Burden of cardiovascular events according to predicted cardiovascular risk across 21 countries: A prospective cohort analysis","volume":"13","author":"Joseph","year":"2025","journal-title":"Lancet Glob. Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Voorbrood, V.M.I., Bohnen, A.M., Bosman, A.P., Rijnbeek, P.R., Rizopoulos, D., and Bindels, P.J.E. (2025). Underestimation of cardiovascular risk by the SCORE2 model in primary care: A call for recalibration. Eur. J. Prev. Cardiol., zwaf253.","DOI":"10.1093\/eurjpc\/zwaf253"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.jacc.2018.10.084","article-title":"Modifiable risk factors in young adults with first myocardial infarction","volume":"73","author":"Yandrapalli","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1038\/nrcardio.2017.154","article-title":"Epidemiology of cardiovascular disease in young individuals","volume":"15","author":"Andersson","year":"2018","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3925","DOI":"10.1093\/eurheartj\/ehac361","article-title":"Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: A European Atherosclerosis Society consensus statement","volume":"43","author":"Kronenberg","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_13","first-page":"e48","article-title":"Lipoprotein(a): A genetically determined, causal, and prevalent risk factor for atherosclerotic cardiovascular disease\u2014AHA scientific statement","volume":"42","author":"Ginsberg","year":"2022","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2104","DOI":"10.1161\/CIRCULATIONAHA.114.014310","article-title":"Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort: The PESA study","volume":"131","author":"Laclaustra","year":"2015","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2401","DOI":"10.1093\/eurheartj\/ehy217","article-title":"Ten-year association of coronary artery calcium with atheroscleroticcardiovascular disease events: The Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"39","author":"Budoff","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_16","unstructured":"Eurostat (2026, May 04). EU Citizens Living in Another EU Member State, 2024. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=EU_population_diversity_by_citizenship_and_country_of_birth."},{"key":"ref_17","unstructured":"Government of Romania, and Ministry of Health (2024). National Plan for the Prevention and Control of Non-Communicable Diseases 2025\u20132030."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4300\/JGME-D-22-00480.1","article-title":"Narrative reviews: Flexible, rigorous, and practical","volume":"14","author":"Sukhera","year":"2022","journal-title":"J. Grad. Med. Educ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_20","unstructured":"SCORE2 Working Group and ESC Cardiovascular Risk Collaboration (2021). SCORE2 risk prediction algorithms: New models to estimate 10-year risk of cardiovascular disease in Europe. Eur. Heart J., 42, 2439\u20132454."},{"key":"ref_21","unstructured":"(2021). SCORE2-OP Working Group and ESC Cardiovascular Risk Collaboration. SCORE2-OP risk prediction algorithms. Eur. Heart J., 42, 2455\u20132467."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"SCORE2-Diabetes Working Group (2023). SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe. Eur. Heart J., 44, 2544\u20132556.","DOI":"10.1093\/eurheartj\/ehad260"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS Guidelines for the management of dyslipidaemias","volume":"41","author":"Mach","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1016\/S0140-6736(18)30664-0","article-title":"Cardiovascular disease risk prediction equations in 400,000 primary-care patients in New Zealand","volume":"391","author":"Pylypchuk","year":"2018","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1056\/NEJMoa1615664","article-title":"Evolocumab and clinical outcomes in patients with cardiovascular disease","volume":"376","author":"Sabatine","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1056\/NEJMoa1912387","article-title":"Two phase-3 trials of inclisiran in patients with elevated LDL cholesterol","volume":"382","author":"Ray","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1056\/NEJMoa1805819","article-title":"Effect of aspirin on cardiovascular events and bleeding in the healthy elderly","volume":"379","author":"McNeil","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"ASCEND Study Collaborative Group (2018). Effects of aspirin for primary prevention in persons with diabetes mellitus. N. Engl. J. Med., 379, 1529\u20131539.","DOI":"10.1056\/NEJMoa1804988"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2935","DOI":"10.1016\/j.jacc.2013.11.005","article-title":"2013 ACC\/AHA Guideline on the Assessment of Cardiovascular Risk","volume":"63","author":"Goff","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1161\/CIRCULATIONAHA.123.067626","article-title":"Development and validation of the American Heart Association\u2019s PREVENT equations","volume":"149","author":"Khan","year":"2024","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1161\/CIRCULATIONAHA.116.025471","article-title":"Coronary artery calcium to guide a personalised risk-based approach to antihypertensive therapy","volume":"135","author":"McEvoy","year":"2017","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1161\/CIRCULATIONAHA.115.018524","article-title":"Role of coronary artery calcium score of zero and other negative risk markers (MESA)","volume":"133","author":"Blaha","year":"2016","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.jacc.2011.01.019","article-title":"Impact of coronary artery calcium scanning on coronary risk factors and downstream testing (EISNER trial)","volume":"57","author":"Rozanski","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"(2018). SCOT-HEART Investigators. Coronary CT angiography and 5-year risk of myocardial infarction. N. Engl. J. Med., 379, 924\u2013933.","DOI":"10.1056\/NEJMoa1805971"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"266","DOI":"10.7326\/M14-1281","article-title":"An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort","volume":"162","author":"DeFilippis","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7326\/M17-3011","article-title":"Clinical implications of revised pooled cohort equations for estimating ASCVD risk","volume":"169","author":"Yadlowsky","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_37","unstructured":"(2026, May 05). Heart Attacks Increasingly Common in Young Adults\u2014Mass General Study. American College of Cardiology, Available online: https:\/\/www.acc.org\/about-acc\/press-releases\/2019\/03\/07\/08\/45\/heart-attacks-increasingly-common-in-young-adults."},{"key":"ref_38","first-page":"75","article-title":"Premature myocardial infarction: A rising threat","volume":"39","author":"Sagris","year":"2022","journal-title":"Balk. Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e029971","DOI":"10.1161\/JAHA.123.029971","article-title":"Acute myocardial infarction: Etiologies and mimickers in young adults","volume":"12","author":"Vaughan","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_40","first-page":"990","article-title":"The PESA study: Rationale and design","volume":"166","author":"Laclaustra","year":"2013","journal-title":"Am. Heart J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3478","DOI":"10.1093\/eurheartj\/eht273","article-title":"Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: Consensus statement","volume":"34","author":"Nordestgaard","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1016\/j.jacc.2020.03.057","article-title":"Worldwide prevalence of familial hypercholesterolemia: Meta-analyses of 11 million subjects","volume":"75","author":"Beheshti","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e002060","DOI":"10.1136\/openhrt-2022-002060","article-title":"Lipoprotein(a) levels in a global population with established ASCVD","volume":"9","author":"Nicholls","year":"2022","journal-title":"Open Heart"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e523","DOI":"10.1161\/CIR.0000000000000564","article-title":"Spontaneous coronary artery dissection: AHA scientific statement","volume":"137","author":"Hayes","year":"2018","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"522","DOI":"10.4330\/wjc.v14.i10.522","article-title":"Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies","volume":"14","author":"Lionakis","year":"2022","journal-title":"World J. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2737","DOI":"10.1161\/01.CIR.99.21.2737","article-title":"Triggering of myocardial infarction by cocaine","volume":"99","author":"Mittleman","year":"1999","journal-title":"Circulation"},{"key":"ref_47","first-page":"1","article-title":"Current Approach and Treatment of Myocardial Infarction Associated with Cocaine Use","volume":"12","author":"Miranda","year":"2024","journal-title":"Med. Res. Arch."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Yun, J.S., Jung, S.H., Shivakumar, M., Xiao, B., Khera, A.V., Park, W.Y., Won, H.H., and Kim, D. (2022). Associations between polygenic risk of coronary artery disease and type 2 diabetes, lifestyle, and cardiovascular mortality: A prospective UK Biobank study. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.919374"},{"key":"ref_49","unstructured":"Joint British Societies (2026, May 05). JBS3 Lifetime-Risk Calculator. Available online: https:\/\/appcardio.com\/jbs3-risk-calculator\/."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.5551\/jat.RV22009","article-title":"Coronary Artery Calcium in Assessment of Atherosclerotic Cardiovascular Disease Risk and its Role in Primary Prevention","volume":"30","author":"Hisamatsu","year":"2023","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1016\/j.jacc.2018.07.079","article-title":"Genomic risk prediction of coronary artery disease in 480,000 adults","volume":"72","author":"Inouye","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.1093\/eurheartj\/ehae466","article-title":"European Society of Cardiology: The 2023 Atlas of Cardiovascular Disease Statistics","volume":"45","author":"Timmis","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1093\/ije\/30.6.1343","article-title":"Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects","volume":"30","author":"Greenland","year":"2001","journal-title":"Int. J. Epidemiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1111\/nep.13861","article-title":"Be careful with ecological associations","volume":"26","author":"Roumeliotis","year":"2021","journal-title":"Nephrology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.jacc.2017.11.014","article-title":"NHLBI working group recommendations to reduce lipoprotein(a)-mediated risk","volume":"71","author":"Tsimikas","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_56","unstructured":"Family Heart Foundation (2026, May 10). New Family Heart Study: Increased Lipoprotein(A) Levels Continuously Increase Risk for Recurrent Cardiovascular Events. Available online: https:\/\/familyheart.org\/lpa-recurrent-ascvd-events-2025."},{"key":"ref_57","unstructured":"Eurostat (2025). EU Citizens Living in Other Member States, 2023 Data, Eurostat."},{"key":"ref_58","unstructured":"(Romania Insider, 2025). Romania Ranks First in EU for Citizens Living in Another Member State. 2024, Romania Insider."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/eurjpc\/zwad318","article-title":"Validation of Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons in the EPIC-Norfolk prospective population cohort","volume":"31","author":"Snaterse","year":"2024","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_60","first-page":"CD016333","article-title":"Risk scoring for the primary prevention of cardiovascular disease","volume":"2","author":"Hernandez","year":"2026","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_61","first-page":"100581","article-title":"Lipoprotein (a) in primary cardiovascular disease prevention is actionable today","volume":"57","author":"Parcha","year":"2025","journal-title":"Am. Heart J. Plus"},{"key":"ref_62","unstructured":"ClinicalTrials.gov (2026, May 10). Assessing the Impact of Lipoprotein (a) Lowering with Pelacarsen (TQJ230) on Major Cardiovascular Events in Patients with CVD (Lp(a)HORIZON). NCT04023552, Available online: https:\/\/clinicaltrials.gov\/study\/NCT04023552."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1056\/NEJMoa2211023","article-title":"OCEAN(a)-DOSE Investigators. Small interfering RNA to reduce lipoprotein(a) in cardiovascular disease (OCEAN(a)-DOSE)","volume":"387","author":"Rosenson","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1001\/jama.2023.21835","article-title":"Lepodisiran, an extended-duration short interfering RNA targeting lipoprotein(a)","volume":"330","author":"Nissen","year":"2023","journal-title":"JAMA"},{"key":"ref_65","unstructured":"ClinicalTrials.gov (2026, May 08). ACCLAIM-Lp(a), NCT06292013, Available online: https:\/\/clinicaltrials.gov\/study\/NCT06292013."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1001\/jama.2024.24017","article-title":"Oral muvalaplin for lowering of lipoprotein(a)","volume":"333","author":"Nicholls","year":"2025","journal-title":"JAMA"},{"key":"ref_67","unstructured":"American College of Cardiology (2026, May 10). Oral Muvalaplin for Lowering of Lipoprotein(a)\u2014KRAKEN. Available online: https:\/\/www.acc.org\/latest-in-cardiology\/clinical-trials\/2024\/11\/17\/17\/01\/kraken."},{"key":"ref_68","unstructured":"Gagel, A.C., Blumenthal, R.S., and Cainzos-Achirica, M. (2026, May 10). The Ever-Growing Role of CAC in Primary Prevention; ACC Latest in Cardiology, 2021. Available online: https:\/\/www.acc.org\/latest-in-cardiology\/articles\/2021\/06\/21\/13\/05\/the-ever-growing-role-of-cac-in-primary-prevention."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1093\/eurjpc\/zwae190","article-title":"Eligibility for lipid-lowering therapy when applying systemic coronary risk estimation 2 according to guidelines on apparently healthy middle-aged individuals","volume":"31","author":"Yari","year":"2024","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.jcmg.2024.05.016","article-title":"Rationale and Design of SCOT-HEART 2 Trial: CT Angiography for the Prevention of Myocardial Infarction","volume":"17","author":"McDermott","year":"2024","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1001\/jamacardio.2019.3780","article-title":"Apolipoprotein B particles and cardiovascular disease: A narrative review","volume":"4","author":"Sniderman","year":"2019","journal-title":"JAMA Cardiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.300.2.197","article-title":"Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: A meta-analysis","volume":"300","author":"Fowkes","year":"2008","journal-title":"JAMA"},{"key":"ref_73","unstructured":"Genomics plc (2026, May 10). AHA 2025: New Study from Genomics Shows Polygenic Risk Scores Improve the Accuracy of Cardiovascular Disease Risk Prediction. American Heart Association Scientific Sessions 2025, New Orleans, LA, USA. Available online: https:\/\/www.genomics.com\/newsroom\/aha-2025-new-study-from-genomics-shows-polygenic-risk-scores-improve-the-accuracy-of-cardiovascular-disease-risk-prediction."},{"key":"ref_74","unstructured":"Khan, S.S., Valente, A.M., and Fornwalt, B.K. (2026, May 10). Coronary artery calcium and polygenic risk scores for cardiovascular risk prediction. American College of Cardiology Clinical Update, Available online: https:\/\/www.acc.org\/latest-in-cardiology\/articles\/2024\/04\/30\/13\/40\/cac-and-polygenic-risk-scores-for-cv-risk-prediction."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1056\/NEJMoa1707914","article-title":"Anti-inflammatory therapy with canakinumab for atherosclerotic disease (CANTOS)","volume":"377","author":"Ridker","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1056\/NEJMoa2021372","article-title":"Colchicine in patients with chronic coronary disease (LoDoCo2)","volume":"383","author":"Nidorf","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1136\/annrheumdis-2016-209775","article-title":"EULAR recommendations for cardiovascular risk management in inflammatory arthritides","volume":"76","author":"Agca","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s11883-020-00864-6","article-title":"The Role of Sex-Specific Risk Factors in the Risk Assessment of Atherosclerotic Cardiovascular Disease for Primary Prevention in Women","volume":"22","author":"Freaney","year":"2020","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1001\/jama.290.7.891","article-title":"Major risk factors as antecedents of fatal and non-fatal coronary heart disease events","volume":"290","author":"Greenland","year":"2003","journal-title":"JAMA"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1161\/CIRCULATIONAHA.105.548206","article-title":"Prediction of lifetime risk for cardiovascular disease by risk-factor burden at 50 years","volume":"113","author":"Leip","year":"2006","journal-title":"Circulation"},{"key":"ref_81","unstructured":"(ESC News, 2025). Romania Sets Concrete Targets for Better Heart Health, ESC News."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1001\/jama.282.21.2012","article-title":"Low risk-factor profile and long-term cardiovascular and non-cardiovascular mortality","volume":"282","author":"Stamler","year":"1999","journal-title":"JAMA"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e002087","DOI":"10.1136\/openhrt-2022-002087","article-title":"Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2","volume":"9","author":"Csenteri","year":"2022","journal-title":"Open Heart"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.atherosclerosis.2011.06.044","article-title":"Carotid plaque versus carotid intima-media thickness for predicting coronary events: Meta-analysis","volume":"220","author":"Inaba","year":"2012","journal-title":"Atherosclerosis"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Vrints, C.J.M., Andreotti, F., Koskinas, K.C., Rossello, X., Adamo, M., Ainslie, J., Banning, A.P., Budaj, A., Buechel, R.R., and Chiariello, G.A. (2024). 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur. Heart J., ehae177.","DOI":"10.1093\/eurheartj\/ehae177"},{"key":"ref_86","unstructured":"European Commission (2025). EU Cardiovascular Health Plan, COM (2025) 1024, European Commission."},{"key":"ref_87","unstructured":"European Society of Cardiology (2026, May 04). National Cardiovascular Health Plans (Overview). Available online: https:\/\/www.escardio.org\/public-health\/eu-cardiovascular-health-plan\/national-cardiovascular-health-plans-new."},{"key":"ref_88","unstructured":"Partnership, H.P. (2026, May 04). Secondary Prevention of Heart Attack and Stroke in Europe\u2014Country Report; Romania, 2024. Available online: https:\/\/www.healthpolicypartnership.com\/project\/secondary-prevention-of-heart-attack-and-stroke\/."},{"key":"ref_89","unstructured":"European Association of Preventive Cardiology (2026, May 04). EAPC Country of the Month\u2014Romania, 2025. Available online: https:\/\/www.escardio.org\/communities\/associations\/eapc\/Advocacy\/prevention-in-your-country\/romania\/."},{"key":"ref_90","unstructured":"PreventNCD, J.A. (2026, May 04). Statement on the Call for Evidence to the EU Cardiovascular Health Plan. Available online: https:\/\/www.preventncd.eu\/media\/nddfdaya\/140925-statement-from-ja-preventncd-on-the-call-for-evidence-to-the-eu-cardiovascular-health-plan-final.pdf."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/S0140-6736(23)00215-5","article-title":"Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy","volume":"401","author":"Ridker","year":"2023","journal-title":"Lancet"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jcct.2016.11.003","article-title":"2016 SCCT\/STR guidelines for coronary artery calcium scoring of non-contrast non-cardiac chest CT scans","volume":"11","author":"Hecht","year":"2017","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1056\/NEJMoa2208275","article-title":"Polypill strategy in secondary cardiovascular prevention","volume":"387","author":"Castellano","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_94","first-page":"60","article-title":"Lipoprotein(a) screening and cardiovascular disease prevention: A population-based modelling study","volume":"31","author":"Kaltoft","year":"2024","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_95","unstructured":"National Institute for Health and Care Excellence (2023). Cardiovascular Disease: Risk Assessment and Reduction, Including Lipid Modification; NG238, NICE."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e748","DOI":"10.1016\/S2214-109X(19)30045-2","article-title":"Socioeconomic status and risk of cardiovascular disease in 20 low-, middle- and high-income countries: The PURE study","volume":"7","author":"Rosengren","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/HJH.0000000000001572","article-title":"Perspectives on hypertension\u2019s prevalence, treatment and control in a high cardiovascular risk East European country: Data from the SEPHAR III survey","volume":"36","author":"Dorobantu","year":"2018","journal-title":"J. Hypertens."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1177\/2047487318825350","article-title":"EUROASPIRE V: Lifestyle, risk factor and therapeutic management","volume":"26","author":"Kotseva","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/jcecho.jcecho_26_25","article-title":"The Role of Imaging in Cardiovascular Prevention: A Comprehensive Review","volume":"35","author":"Carerj","year":"2025","journal-title":"J. Cardiovasc. Echogr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5490\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T04:11:06Z","timestamp":1784347866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":99,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145490"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145490","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]}}}