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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

Circulation (New York, N.Y.), 2019-06, Vol.139 (25), p.e1162-e1177 [Peer Reviewed Journal]

2019 by the American College of Cardiology Foundation and the American Heart Association, Inc. ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIR.0000000000000638 ;PMID: 30586766

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Title:
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
Author: Lloyd-Jones, Donald M ; Braun, Lynne T ; Ndumele, Chiadi E ; Smith, Sidney C ; Sperling, Laurence S ; Virani, Salim S ; Blumenthal, Roger S
Subjects: Adult ; Age Factors ; Aged ; Antihypertensive Agents - adverse effects ; Antihypertensive Agents - therapeutic use ; Atherosclerosis - diagnosis ; Atherosclerosis - epidemiology ; Atherosclerosis - prevention & control ; Clinical Decision-Making ; Consensus ; Decision Support Techniques ; Evidence-Based Medicine ; Female ; Health Status ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Male ; Middle Aged ; Patient Selection ; Predictive Value of Tests ; Primary Prevention ; Protective Factors ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk Factors ; Sex Factors ; Treatment Outcome
Is Part Of: Circulation (New York, N.Y.), 2019-06, Vol.139 (25), p.e1162-e1177
Description: 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.
Publisher: United States: by the American College of Cardiology Foundation and the American Heart Association, Inc
Language: English
Identifier: ISSN: 0009-7322
EISSN: 1524-4539
DOI: 10.1161/CIR.0000000000000638
PMID: 30586766
Source: GFMER Free Medical Journals
MEDLINE

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