Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology

Donald M. Lloyd-Jones, Lynne T. Braun, Chiadi E. Ndumele, Sidney C. Smith, Laurence S. Sperling, Salim S. Virani, Roger S. Blumenthal

Research output: Contribution to journalArticle

Abstract

Risk assessment is a critical step in the current approach to primary prevention of atherosclerotic cardiovascular disease. Knowledge of the 10-year risk for atherosclerotic cardiovascular disease identifies patients in higher-risk groups who are likely to have greater net benefit and lower number needed to treat for both statins and antihypertensive therapy. Current US prevention guidelines for blood pressure and cholesterol management recommend use of the pooled cohort equations to start a process of shared decision-making between clinicians and patients in primary prevention. The pooled cohort equations have been widely validated and are broadly useful for the general US clinical population. But, they may systematically underestimate risk in patients from certain racial/ethnic groups, those with lower socioeconomic status or with chronic inflammatory diseases, and overestimate risk in patients with higher socioeconomic status or who have been closely engaged with preventive healthcare services. If uncertainty remains for patients at borderline or intermediate risk, or if the patient is undecided after a patient-clinician discussion with consideration of risk enhancing factors (eg, family history), additional testing with measurement of coronary artery calcium can be useful to reclassify risk estimates and improve selection of patients for use or avoidance of statin therapy. This special report summarizes the rationale and evidence base for quantitative risk assessment, reviews strengths and limitations of existing risk scores, discusses approaches for refining individual risk estimates for patients, and provides practical advice regarding implementation of risk assessment and decision-making strategies in clinical practice.

Original languageEnglish (US)
Pages (from-to)e1162-e1177
JournalCirculation
Volume139
Issue number25
DOIs
StatePublished - Jun 18 2019

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Primary Prevention
Decision Making
Cardiovascular Diseases
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Social Class
Numbers Needed To Treat
Ethnic Groups
Patient Selection
Antihypertensive Agents
Uncertainty
Coronary Vessels
Chronic Disease
Cholesterol
Guidelines
Blood Pressure
Calcium
Delivery of Health Care
Therapeutics
Population

Keywords

  • AHA Scientific Statements
  • atherosclerotic cardiovascular disease
  • prevention
  • primary prevention
  • relative risk
  • risk assessment
  • secondary prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease : A Special Report From the American Heart Association and American College of Cardiology. / Lloyd-Jones, Donald M.; Braun, Lynne T.; Ndumele, Chiadi E.; Smith, Sidney C.; Sperling, Laurence S.; Virani, Salim S.; Blumenthal, Roger S.

In: Circulation, Vol. 139, No. 25, 18.06.2019, p. e1162-e1177.

Research output: Contribution to journalArticle

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