NEW GUIDELINES ON CARDIOVASCULAR RISK ASSESSMENT


Nathan D. Wong, Ph.D., University of California, Irvine, CA, USA

The Framingham Heart Study first noted that risk functions for predicting cardiovascular disease (CVD) risk provide an efficient way for identifying persons at high risk who need preventive therapy; this led to future recommendations regarding the targeting of the intensity of therapy to a patient’s global risk. Risk scores including those of Framingham, PROCAM, and European SCORE provide estimates for 10-year risk of hard or total CHD or CVD events. The ACC/AHA 2013 guidelines for CVD risk assessment specify use of a Pooled Cohort Equations score for predicting 10-year and lifetime risk of ASCVD including both nonfatal and fatal myocardial infarction and stroke and are recommended for use in those aged 40-79 years of age; those aged 20-59 years of age with a low estimated risk are recommended to be evaluated with lifetime risk as well. When the treatment decision is uncertain, the guidelines recommend consideration of use of premature family history of CVD, hs-C-reactive protein, ankle brachial index, or coronary calcium scoring to further stratify the person’s risk of CVD. A positive premature family history with CVD <55 years of age in a male first degree relative or <65 years of age in a female first degree relative, a hs-CRP of >2 mg/L, ankle brachial index <0.9, or coronary calcium score of >=300 or >=75%tile for age, ethnicity and gender are suitable to stratify the individual’s CVD risk upward for consideration of initiation or intensification of therapy. Incorporation of global risk scoring into electronic medical records systems for rapid accessibility to the healthcare provider when seeing the patient, as well as accessibility to required measures and further testing will be key in successful implementation of the recent recommendations for CVD risk assessment.