2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

BySteven Lome, MD

Year released: 2013

Societies: American College of Cardiology (ACC), American Heart Association (AHA)

Collaboration: National Heart, Lung, and Blood Institute (NHLBI)

Summary:

These prevention guidelines differ from previous guidelines published by the ACC and AHA, according to the writing committee.

As opposed to an extensive collection of clinical information, these documents are more limited in scope and focus on selected critical questions regarding certain topics that are based on quality evidence, according to the review panel.

Additionally, the text that accompanies each recommendation is rather succinct, summarizing the evidence for each critical question. The full panel reports include more detailed information about the evidence statements that serves as the basis for recommendations, according to the writing committee.

The panel placed recommendations into various classes to help identify the strength of each recommendation. Anything labeled as class I was considered strong, recommended and should be performed or administered. Anything labeled class III had no benefit or the risk outweighs the benefit.

Risk assessment

A class I recommendation suggests that the race- and gender-specific Pooled Cohort Equations to predict 10-year risk for a first hard atherosclerotic cardiovascular disease (ASCVD) event should be used in non-Hispanic black adults and non-Hispanic white adults aged 40 to 79 years.

Although not a class I recommendation, it is reasonable to assess traditional ASCVD risk factors every 4 to 6 years in adults aged 20 to 79 years who are free from ASCVD and to estimate 10-year ASCVD risk every 4 to 6 years in adults aged 40 to 79 years without ASCVD.

The committee, however, wrote that carotid intima-media thickness is not recommended for routine measurement in clinical practice for risk assessment for a first ASCVD event.

The panel endorses the existing paradigm of matching the intensity of preventive efforts with an individual’s absolute risk, but it acknowledges that none of the risk assessment tools examined in the present document have been formally evaluated in randomized controlled trials of screening strategies with clinical events as outcomes.

Nevertheless, the approach balances an understanding of an individual’s absolute risk for CVD and potential treatment benefits against the potential absolute risks for harm from therapy, according to the committee.

Implementation considerations for risk assessment

The committee wrote that it is reasonable to assess ASCVD risk factors in younger and older individuals, but limitations in available data prevented the development of robust risk assessment algorithms in these populations.

For patients outside those age ranges, providers should refer to applicable clinical practice guidelines and adult primary prevention guidelines.

Evidence gaps and future research needs

The committee strongly recommends continued research to fill gaps in knowledge regarding short- and long-terms ASCVD risk assessment and outcomes in all race and ethnic groups, across the age spectrum, and in both men and women.

Additionally, the panel suggests that future research should include analyses of short- and long-term risk in diverse groups; optimal communication of ASCVD risk information; utility of short- and long-term risk assessment for motivating behavioral change and adherence to therapy; utility of short- and long-term risk assessment for influencing risk factor levels and clinical outcomes; utility of differential information conveyed by short- and long-term risk assessment; and utility of novel risk markers in short- and long-term risk assessment.

Goff DC Jr, et al. J Am Coll Cardiol. 2014;doi:10.1016/j.jacc.2013.11.005.

Cardiology Today coverage: https://www.healio.com/cardiology/chd-prevention/news/online/%7B447dbedb-5424-475a-b0f9-adaf57c3e17f%7D/new-risk-score-could-improve-identification-of-people-at-risk-for-cvd