From Risk Markers to Preventive Action: A Proposed Semi-Quantitative Clinical Actionability Framework for Cardiometabolic Precision Prevention in Primary Care—A Narrative Review
- 1“Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
Abstract
Cardiometabolic prevention in primary care draws on a growing number of risk markers, yet a marker’s capacity to predict risk is often conflated with its capacity to change management. This narrative review proposes a semi-quantitative clinical actionability framework that takes the marker–context–action use case as its unit of appraisal and assigns ordinal scores (0–3) to seven domains: measurement readiness, prognostic validity, decision-relevant information, therapeutic linkage, clinical-utility evidence, harms and burden, and transportability and equity. Gating rules prevent prognostic strength alone from determining the tier. Applied by the authors to 19 use cases, the framework provisionally assigned five to Tier A (routine actionability): low-density lipoprotein cholesterol, blood pressure, type 2 diabetes detection, kidney function with albuminuria in diabetes or hypertension, and familial hypercholesterolaemia case-finding. Nine were assigned to Tier B (selective actionability), including the coronary artery calcium, apolipoprotein B, lipoprotein(a), natriuretic peptide and ankle–brachial index use cases, three to Tier C and two to Tier D. Most assignments depended on one-point differences in therapeutic linkage or clinical-utility scores. Tiers describe evaluated use cases, not intrinsic marker properties; the framework has not been validated. It implies that closing implementation gaps in Tier A use cases should generally precede the introduction of newer markers.
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BibTeX
@article{petroaie2026from,
title = {{From Risk Markers to Preventive Action: A Proposed Semi-Quantitative Clinical Actionability Framework for Cardiometabolic Precision Prevention in Primary Care—A Narrative Review}},
author = {Antoneta Dacia Petroaie and Elena Teona Cosovanu and Eric Oliviu Cosovanu and Otilia Novac and Ana Maria Slanina and Elena Popa and Agnes Iacinta Bacusca and Mihaela Manole and Monica Iuliana Ungureanu and Carmen Liliana Barbacariu and Luiza Simona Pohaci Antonesei and Manuela Stefan and Elena Adorata Coman},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218706},
url = {https://www.mdpi.com/2077-0383/15/21/8706},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From Risk Markers to Preventive Action: A Proposed Semi-Quantitative Clinical Actionability Framework for Cardiometabolic Precision Prevention in Primary Care—A Narrative Review
AU - Antoneta Dacia Petroaie
AU - Elena Teona Cosovanu
AU - Eric Oliviu Cosovanu
AU - Otilia Novac
AU - Ana Maria Slanina
AU - Elena Popa
AU - Agnes Iacinta Bacusca
AU - Mihaela Manole
AU - Monica Iuliana Ungureanu
AU - Carmen Liliana Barbacariu
AU - Luiza Simona Pohaci Antonesei
AU - Manuela Stefan
AU - Elena Adorata Coman
PY - 2026
DA - 2026/11/07
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218706
UR - https://www.mdpi.com/2077-0383/15/21/8706
AB - Cardiometabolic prevention in primary care draws on a growing number of risk markers, yet a marker’s capacity to predict risk is often conflated with its capacity to change management. This narrative review proposes a semi-quantitative clinical actionability framework that takes the marker–context–action use case as its unit of appraisal and assigns ordinal scores (0–3) to seven domains: measurement readiness, prognostic validity, decision-relevant information, therapeutic linkage, clinical-utility evidence, harms and burden, and transportability and equity. Gating rules prevent prognostic strength alone from determining the tier. Applied by the authors to 19 use cases, the framework provisionally assigned five to Tier A (routine actionability): low-density lipoprotein cholesterol, blood pressure, type 2 diabetes detection, kidney function with albuminuria in diabetes or hypertension, and familial hypercholesterolaemia case-finding. Nine were assigned to Tier B (selective actionability), including the coronary artery calcium, apolipoprotein B, lipoprotein(a), natriuretic peptide and ankle–brachial index use cases, three to Tier C and two to Tier D. Most assignments depended on one-point differences in therapeutic linkage or clinical-utility scores. Tiers describe evaluated use cases, not intrinsic marker properties; the framework has not been validated. It implies that closing implementation gaps in Tier A use cases should generally precede the introduction of newer markers.
SN - 2077-0383
ER -