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Guidelines for Assessment of Cardiovascular Risk

Guideline Watch |
November 12, 2013

Guidelines for Assessment of Cardiovascular Risk

  1. Kirsten E. Fleischmann, MD, MPH

A new global risk assessment tool makes its debut, and nontraditional risk factors take a back seat.

  1. Kirsten E. Fleischmann, MD, MPH

Sponsoring Organizations: American College of Cardiology, American Heart Association

Target Population: Primary care providers, cardiologists

Background and Objective

The ACC/AHA Task Force based these recommendations on a comprehensive report from an Expert Work Group convened by the National Heart, Lung, and Blood Institute. The Work Group was asked to (1) develop an approach to quantitative risk assessment for cardiovascular disease that could be used to guide care; and (2) address key questions in risk assessment using systematic review methods.

Key Points

  • New, sex-specific Pooled Cohort Equations were developed from multiple large cohorts to predict the 10-year risk for a first atherosclerotic cardiovascular disease event (ASCVD; nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke) and are recommended for non-Hispanic blacks and non-Hispanic whites.

  • The Pooled Cohort Equations may also be used in other populations, keeping in mind that the validity of the model is not as well established as in non-Hispanic blacks and whites.

  • Inputs for the new equations include age, sex, cholesterol (total and HDL) and blood-pressure values, and information on other standard risk factors.

  • If, after risk assessment, the treatment decision is still uncertain, assessment of family history, high-sensitivity C-reactive protein, coronary artery calcium, or ankle-brachial index may be considered.

  • Routine measurement of carotid intima-media thickness (CIMT) is not recommended for assessment of risk for a first ASCVD event.

  • The incremental value of apolipoprotein B, chronic kidney disease, albuminuria, and cardiorespiratory fitness in risk assessment for a first ASCVD event is uncertain.

What's Changed

This document supplants guidelines published by the ACC/AHA in 2010 (NEJM JW Cardiol Feb 9 2011). Notable changes from the previous guidelines include the endorsement of a specific model for global risk assessment and a diminution of the role of CIMT measurement.

Comment

These guidelines introduce new equations for assessing the 10-year (and also lifetime) risk for a first cardiovascular event. Calculators are available in downloadable form online and are relatively easy to use. Links to the equations are included in treatment algorithms contained in concomitantly released guidelines for management of cholesterol for primary prevention (NEJM JW Gen Med Nov 12 2013.

  • Disclosures for Kirsten E. Fleischmann, MD, MPH at time of publication Grant / research support NIH Leadership positions in professional societies American College of Cardiology and American Heart Association (Vice Chair, Writing Committee for Guidance on Cardiovascular Evaluation and Care for Noncardiac Surgery)

Citation(s):

Reader Comments (12)

Delilah Ng, MD Physician, Internal Medicine

Since release of guidelines, there are many simple and to use to the point mobile applications ideal resource for all healthcare professionals. List below are FREE apps include the newly release android app, ASCVD Risk Estimator from American College of Cardiology:

iOS App:
1) Cardiac Risk Assist - ASCVD Pooled Cohort Equations by Tin Nguyen, MD.. Jennifer G Robinson, MD, MPH. It seems like this app was the prototype for ACC/AHA mobile app (http://www.cvriskassist.com/)
2) Pooled Cohort Equations ASCVD Risk Calculator by Nathaniel Lee, Paul Lee MD (http://2013riskcalculator.weebly.com/)
3) Cardiovascular Risk 2013 by Austin Physician Productivity, LLC (http://statcoder.com/)
4) ASCVD Risk Estimator from American College of Cardiology coming soon to iOS..

Android App
1) ASCVD Risk Estimator by American College of Cardiology Foundation - Just RELEASE Feb 3, 2014 (https://play.google.com/store/apps/details?id=org.acc.cvrisk&hl=en)
2) MediCalc® by ScyMed Inc. (http://www.scymed.com/)

Joel Berick Other Healthcare Professional, Dentistry, Private practice

very interesting

Cassandra Harrison MD Physician, Internal Medicine, Hospital

Your risk calculator does not provide a scoring system to calculate risk. How can you call this a calculator? It's worthless as a calculator. Please provide a 10 yr risk calculator wherein values are placed for each significant clinical, demographic and lab value of interest into an equation to yield a score. Is that so hard to ask?

Cynthia Pascual, MD Physician, Family Medicine/General Practice, Mishawaka, IN

There is an app that is available on iphone/ipad
called ASCVD risk calculator pooled cohort equations by Kane which gives both 10yr and lifetime risk ($0.99) and another one by Dr Lee fr Mt SinaI School of Medicine which calculates just 10 yr risk for free.
Just search ASCVD Risk calculator pooled cohort equations and there will be 3 choices of which the first 2 choices are the ones I describe above.

Julie Sierra, MD Physician, Internal Medicine, Community Health Center

There is an app called ASCVD that is 99 cents to install. Very easy to use.

HAROON RASUL; Physician, Cardiology, Hospital

Good to get academic knoeledge

Paul Nickerson MD Physician, Internal Medicine

Interested in the algorithms for risk.

Jacques Michel MD Physician, Infectious Disease, Hadassah Medical Organization Jerusalen Israel

This is really promoting Evidence-based medicine

Alan Davidson III, M.D. Physician, Emergency Medicine, Moses H. Cone Memorial Hospital ED

I was unable to access the risk calculator for a first cardiovascular event.

Herbert Jelinek Other, Other

This is a very timely and exciting change in the screening of CVD and CVD risk with a notable change in direction towards using emerging risk markers that have been shown in large trials to identify rcurrent risk but do not provide additional insight into the pathophysiology of disease progression. This is where I believe the most impact can be made in the future

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