In Spain, as in most Mediterranean countries, death rates from cardiovascular diseases have traditionally been lower compared with those in Anglo-Saxon and northern and central Europe . However, they are still a priority public health problem because vascular diseases contribute to 30% of total mortality in developed countries, 56 million deaths worldwide, of which more than 125, 000 are in Spain . The European guideline for vascular prevention  recommends that prevention strategies should include three main components: 1) a population strategy to try to change lifestyle, social, environmental and economic factors which are highly related to the disease occurrence 2) a secondary prevention strategy to reduce recurrences, complications rates and improve the disease prognostic and 3) a primary prevention strategy in high-risk population in which different interventions are more efficient than in general and low-risk population. In this last strategy, the key element is to identify these individuals through the use of risk functions. This strategy has some limitations at present, since sometimes the performance of such functions is insufficient, especially in patients classified as intermediate-risk (5-15% risk at 10 years) . Several attempts to improve risk functions by using new risk factors markers have not increased their predictive ability, because of the autocorrelation of these emerging factors with classical risk ones [5, 6]. With the available evidence we cannot assess the balance between risks and benefits of the studied factors for its widespread use in asymptomatic men and women with no history of coronary disease . The general conclusion is that this issue is a priority in vascular prevention research.
There are three opportunity areas to improve the risk estimation in intermediate-risk population:
1. The measure of subclinical atherosclerosis: Markers of atherosclerotic burden are the most reliable candidates to identify patients at increased risk of the intermediate-risk group . Values below 0.9 on the ankle brachial index (ABI) are associated with an increased risk of coronary heart disease events and mortality, regardless of calculated risk by the Framingham equation , even in asymptomatic patients . Therefore, ABI at baseline provides extra prognostic information which is not provided by the measurement of conventional risk factors alone. In our country, results have also been reported to confirm this assumption, since ABI values < 0.9 have been found to be relatively common in asymptomatic patients with coronary risk at 10 years less than 10% .
Arterial stiffness is also a parameter that is considered as a possible good marker of cardiovascular risk [12, 13]. Traditionally, it has been quantified by pulse wave velocity (PWV). The Cardio Ankle Vascular Index (CAVI) is an index representing the stiffness of the aorta, femoral artery and tibial artery . Some authors suggest that CAVI measurement, which is independent of blood pressure and has an adequate reproducibility for clinical use, is more useful as a marker of arterial stiffness than PWV .
2. The incorporation of more detailed and accurate assessment of traditional risk factors: The glycated hemoglobin (HbA1c) is a more accurate and stable measure than fasting glucose concentration . It is more and more suggested that HbA1c concentration is not only a useful marker in patients with DM, but can also be useful to identify patients at higher risk of developing cardiovascular problems in the general population. In this regard, a recent study shows that high levels of HbA1c are associated with the occurrence of cardiovascular disease in nondiabetic patients  and high values of this type of hemoglobin are common in general adult population with no history of diabetes .
Postprandial glucose concentration has negative effects on the arterial wall and several studies have shown that a good control of postprandial glucose can revert to a reduction of cardiovascular events and mortality [19, 20].
Self-measured blood pressure has a significant correlation with cardiovascular morbidity and mortality  and its control has some advantages such as being easily accessible and comfortable for the patient. It also has the possibility of performing multiple measurements on non-medical environment, so that white coat effect is avoided.
3. The incorporation of a comprehensive and contextualized evaluation of the patient taking into account his co-morbidity: Several studies have highlighted the importance of the presence of certain chronic diseases in vascular diseases development. There are arguments supporting that the presence of chronic obstructive pulmonary disease , atrial fibrillation , renal disease  and depression  among others are associated, independently, with an increased incidence of vascular disease. Just as the high score on composite indices of co-morbidity, has been associated with a worse prognosis of vascular diseases . This suggests that this information may be useful for risk stratification, even in primary prevention.
Thus, these three lines of analysis and the proposed variables have significant scientific support as candidates to improve the population risk classification. They are also measures that can be easily and economically obtained and can be implemented in primary care, which is suitable for the population screening. The demonstration of the usefulness of some of these factors in re-stratify the population's risk will have a major impact on the primary prevention of the vascular diseases with all that this implies at the Public Health level. All this justifies the proposal to analyze their contribution to improve the predictive ability of the existing risk functions.
To analyze whether the ABI and arterial stiffness measures (pulse wave velocity and cardio ankle vascular index) are associated independently with the incidence of vascular events and whether they can help to improve the predictive ability of risk equations based on traditional risk factors in intermediate-risk population.
To analyze whether the postprandial capillary glucose, glycated hemoglobin, and self-blood pressure measurement are associated independently with the incidence of vascular events and whether they can help to improve the predictive ability of risk equations based on classical risk factors in intermediate-risk population.
To analyze whether the presence of comorbidity measured by composite indices (Charlson Index, Cumulative Illness Rating score) is associated independently with the incidence of vascular events and whether they can help to improve the predictive ability of risk equations based on classical risk factors in intermediate-risk population.