Guidelines for Assessment of Cardiovascular Risk

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.