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Center for Human Nutrition, Departments of Internal Medicine, Applied Clinical Research, University of Texas Southwestern Medical Center and The Veterans Administration North Texas Healthcare System, Dallas, Texas
Division of Cardiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IllinoisDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Quantification of risk for atherosclerotic cardiovascular disease (ASCVD) is important.
Traditional risk assessment begins with numerical estimation. The pooled-cohort equation
(PCE), as described in the 2018 American Hospital Association/American College of
Cardiology/MultiSociety guidelines, serves as the basis for 10-year ASCVD-risk estimation.
2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA /AGS/APhA/ASPC/NLA/PCNA guideline on the management
of blood cholesterol: a report of the American College of Cardiology/American Heart
Association Task Force on Clinical Practice guidelines.
Although the PCE has been verified in a natural history cohort, the reliability of
the equation in contemporary US subpopulations has been debated for those in the intermediate
range of risk.
The guidelines thereby recommend a patient-oriented risk discussion and clinical
risk assessment precede the prescription of statin therapy because patient-specific
insights can inform treatment decisions.
2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA /AGS/APhA/ASPC/NLA/PCNA guideline on the management
of blood cholesterol: a report of the American College of Cardiology/American Heart
Association Task Force on Clinical Practice guidelines.
Moreover, to refine individual risk, the guidelines propose evaluation of a panel
of risk-enhancing factors (REFs) (Figure 1). Coronary artery calcium (CAC) scoring has also been proposed as a tool to stratify
risk in the setting of clinical uncertainty. Nevertheless, the approach to incorporating
REFs and CAC scoring in patient-oriented risk discussions and clinical decision-making
remains unclear.
The use of risk enhancing factors to personalize ASCVD risk assessment: evidence and
recommendations from the 2018 AHA/ACC multi-society cholesterol guidelines.
Here, we aim to highlight the utility of incorporating REFs in patient-oriented risk
discussions that are grounded in a risk score, introduce studies demonstrating quantitative
value in cataloging REF burden, and illustrate utility in CAC scoring.
Figure 1REFs in the clinician-patient risk discussion for those at risk of atherosclerotic
cardiovascular disease. The content presented is adapted from Figure 2 of the 2018
AHA/ACC/MultiSociety Guideline on the management of blood cholesterol to illustrate
the usefulness of risk enhancing factors and is not intended to replace said figure
as a practice guideline.
2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA /AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines.
The use of risk enhancing factors to personalize ASCVD risk assessment: evidence and recommendations from the 2018 AHA/ACC multi-society cholesterol guidelines.
Shared decision making and patient reported outcomes among adults with atherosclerotic cardiovascular disease, medical expenditure panel survey 2006–2015.
Prognostic utility of risk enhancers and coronary artery calcium score recommended in the 2018 ACC/AHA Multisociety Cholesterol Treatment guidelines over the pooled cohort equation: insights from 3 large prospective cohorts.
Assessment of coronary artery calcium scoring to guide statin therapy allocation according to risk-enhancing factors: the Multi-Ethnic Study of Atherosclerosis.
