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Global Approaches to Risk Assessment: The US Guidelines

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Cardiovascular Risk Assessment in Primary Prevention

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Assessment of atherosclerotic cardiovascular disease (ASCVD) risk and matching the intensity of prevention efforts to this estimated risk are the cornerstones of cardiovascular disease prevention. The current US guidelines for cardiovascular risk assessment recommend using the race- and sex-specific pooled cohort equations for estimating the 10-year risk of ASCVD among asymptomatic individuals, which is the starting point for shared decision-making in primary ASCVD prevention. In addition, identification of risk-enhancing factors, estimation of lifetime cardiovascular risk when warranted, and utilization of coronary artery calcium testing when appropriate can be used for both personalizing and refining risk estimates. Although cardiovascular risk assessment has evolved and improved significantly over the past few decades, further advances are needed. Future investigation should focus on improving cardiovascular risk assessment by studying larger and more diverse epidemiological cohorts, leveraging the power of precision medicine, and incorporating measures of social determinants of health into risk prediction algorithms.

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References

  • All of Us Research Program Investigators, Denny JC, Rutter JL. The “All of Us” Research Program. N Engl J Med. 2019;381:668–76.

    Article  Google Scholar 

  • Ankle Brachial Index Collaboration, Fowkes FGR, Murray GD. Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008;300:197–208.

    Article  PubMed Central  Google Scholar 

  • Anurag M, Virani SS, Ayers CR, Wensheng S, Hoogeveen RC, Anand R, Berry JD, Joshi PH, Ballantyne CM, Amit K. Lipoprotein(a) and family history predict cardiovascular disease risk. J Am Coll Cardiol. 2020;76:781–93.

    Article  CAS  Google Scholar 

  • Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–646.

    PubMed  PubMed Central  Google Scholar 

  • Baber U, Mehran R, Sartori S, et al. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. J Am Coll Cardiol. 2015;65:1065–74.

    Article  PubMed  Google Scholar 

  • Bild DE, Bluemke DA, Burke GL, et al. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002;156:871–81.

    Article  PubMed  Google Scholar 

  • Brunner FJ, Waldeyer C, Ojeda F, et al. Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium. Lancet. 2019;394:2173–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Choi SW, Mak TS-H, O’Reilly PF. Tutorial: a guide to performing polygenic risk score analyses. Nat Protoc. 2020;15:2759–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cook NR, Ridker PM. Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women’s Health Study. JAMA Intern Med. 2014;174:1964–71.

    Article  PubMed  PubMed Central  Google Scholar 

  • DeFilippis AP, Young R, Carrubba CJ, McEvoy JW, Budoff MJ, Blumenthal RS, Kronmal RA, McClelland RL, Nasir K, Blaha MJ. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015;162:266–75.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dzaye O, Dardari ZA, Cainzos-Achirica M, et al. Warranty period of a calcium score of zero: comprehensive analysis from the Multiethnic Study of Atherosclerosis. JACC Cardiovasc Imaging. 2020; https://doi.org/10.1016/j.jcmg.2020.06.048.

  • Elias-Smale SE, Proenca RV, Koller MT, Kavousi M, van Rooij FJ, Hunink MG, Steyerberg EW, Hofman A, Oudkerk M, Witteman JC. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol. 2010;56:1407–14.

    Article  PubMed  Google Scholar 

  • Elliott J, Bodinier B, Bond TA, Chadeau-Hyam M, Evangelou E, Moons KGM, Dehghan A, Muller DC, Elliott P, Tzoulaki I. Predictive accuracy of a polygenic risk score-enhanced prediction model vs a clinical risk score for coronary artery disease. JAMA. 2020;323:636–45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56:1397–406.

    Article  PubMed  Google Scholar 

  • Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2935–59.

    Article  PubMed  Google Scholar 

  • Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary calcium score and cardiovascular risk. J Am Coll Cardiol. 2018;72:434–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Grundy SM. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab. 2004;89:2595–600.

    Article  CAS  PubMed  Google Scholar 

  • Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:3168–209.

    Article  PubMed  Google Scholar 

  • Hlatky MA, Philip G, Arnett DK, et al. Criteria for evaluation of novel markers of cardiovascular risk. Circulation. 2009;119:2408–16.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hoffmann U, Massaro JM, D’Agostino RB, Kathiresan S, Fox CS, O’Donnell CJ. Cardiovascular event prediction and risk reclassification by coronary, aortic, and valvular calcification in the Framingham Heart Study. J Am Heart Assoc. 2016;5:e003144. https://doi.org/10.1161/JAHA.115.003144.

    Article  PubMed  PubMed Central  Google Scholar 

  • Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, Januzzi JL, Scott NS, Natarajan P. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA. 2019a;322:2411–21. https://doi.org/10.1001/jama.2019.19191.

    Article  PubMed  PubMed Central  Google Scholar 

  • Honigberg MC, Maryam ZS, Krishna A, Derek K, Bhatt DL, Scott NS, Peloso GM, Pradeep N. Long-term cardiovascular risk in women with hypertension during pregnancy. J Am Coll Cardiol. 2019b;74:2743–54.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jaiswal S, Natarajan P, Silver AJ, et al. Clonal hematopoiesis and risk of atherosclerotic cardiovascular disease. N Engl J Med. 2017;377:111–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanaya AM, Kandula N, Herrington D, Budoff MJ, Hulley S, Vittinghoff E, Liu K. Mediators of atherosclerosis in South Asians living in America (MASALA) study: objectives, methods, and cohort description. Clin Cardiol. 2013;36:713–20.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J. Factors of risk in the development of coronary heart disease--six year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50.

    Article  CAS  PubMed  Google Scholar 

  • Karmali KN, Goff DC, Ning H, Lloyd-Jones DM. A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2014;64:959–68.

    Article  PubMed  Google Scholar 

  • Kavousi M, Leening MJ, Nanchen D, Greenland P, Graham IM, Steyerberg EW, Ikram MA, Stricker BH, Hofman A, Franco OH. Comparison of application of the ACC/AHA guidelines, adult treatment Panel III guidelines, and European Society of Cardiology guidelines for cardiovascular disease prevention in a European cohort. JAMA. 2014;311:1416–23.

    Article  PubMed  CAS  Google Scholar 

  • Khera AV, Emdin CA, Drake I, et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med. 2016;375:2349–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Khera AV, Chaffin M, Aragam KG, et al. Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nat Genet. 2018;50:1219–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lee ET, Welty TK, Fabsitz R, Cowan LD, Le NA, Oopik AJ, Cucchiara AJ, Savage PJ, Howard BV. The Strong Heart Study. A study of cardiovascular disease in American Indians: design and methods. Am J Epidemiol. 1990;132:1141–55.

    Article  CAS  PubMed  Google Scholar 

  • Lewis GD, Asnani A, Gerszten RE. Application of metabolomics to cardiovascular biomarker and pathway discovery. J Am Coll Cardiol. 2008;52:117–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Libby P, Sidlow R, Lin AE, et al. Clonal hematopoiesis: crossroads of aging, cardiovascular disease, and cancer: JACC review topic of the week. J Am Coll Cardiol. 2019;74:567–77.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lindsey ML, Manuel M, Gomes AV, et al. Transformative impact of proteomics on cardiovascular health and disease. Circulation. 2015;132:852–72.

    Article  CAS  PubMed  Google Scholar 

  • Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC, Sperling LS, Virani SS, Blumenthal RS. 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. J Am Coll Cardiol. 2019;73:3153–67.

    Article  PubMed  Google Scholar 

  • Mehta A, Blaha MJ, Miller J III, Joshi PH. Coronary artery calcium scoring: a valuable aid in shared decision making among non-traditional risk markers. Curr Cardiovasc Imaging Rep. 2017;10:33. https://doi.org/10.1007/s12410-017-9431-3.

    Article  Google Scholar 

  • Mehta A, Singh S, Saeed A, Mahtta D, Bittner VA, Sperling LS, Virani SS. Pathophysiological mechanisms underlying excess risk for diabetes and cardiovascular disease in South Asians: the perfect storm. Curr Diabetes Rev. 2020; https://doi.org/10.2174/1573399816666200703182458.

  • Michael M, Stone NJ, Christie B, et al. Triglycerides and cardiovascular disease. Circulation. 2011;123:2292–333.

    Article  Google Scholar 

  • Mosley JD, Gupta DK, Tan J, et al. Predictive accuracy of a polygenic risk score compared with a clinical risk score for incident coronary heart disease. JAMA. 2020;323:627–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Muntner P, Colantonio LD, Cushman M, Goff DC, Howard G, Howard VJ, Kissela B, Levitan EB, Lloyd-Jones DM, Safford MM. Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations. JAMA. 2014;311:1406–15.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Paixao AR, Ayers CR, El Sabbagh A, et al. Coronary artery calcium improves risk classification in younger populations. JACC Cardiovasc Imaging. 2015;8:1285–93.

    Article  PubMed  Google Scholar 

  • Pedrotty DM, Morley MP, Cappola TP. Transcriptomic biomarkers of cardiovascular disease. Prog Cardiovasc Dis. 2012;55:64–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Perreira KM, de LA Abreu M, Zhao B, et al. Retaining hispanics: lessons from the Hispanic Community Health Study/Study of Latinos. Am J Epidemiol. 2020;189:518–31.

    Article  PubMed  PubMed Central  Google Scholar 

  • Polonsky TS, McClelland RL, Jorgensen NW, Bild DE, Burke GL, Guerci AD, Greenland P. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303:1610–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ramaswami R, Bayer R, Galea S. Precision medicine from a public health perspective. Annu Rev Public Health. 2018;39:153–68.

    Article  PubMed  Google Scholar 

  • Sarnak MJ, Amann K, Bangalore S, et al. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J Am Coll Cardiol. 2019;74:1823–38.

    Article  CAS  PubMed  Google Scholar 

  • Schultz WM, Kelli HM, Lisko JC, et al. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation. 2018;137:2166–78.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sempos CT, Bild DE, Manolio TA. Overview of the Jackson heart study: a study of cardiovascular diseases in African American Men and Women. Am J Med Sci. 1999;317:142–6.

    Article  CAS  PubMed  Google Scholar 

  • Silverman MG, Ference BA, Im K, Wiviott SD, Giugliano RP, Grundy SM, Braunwald E, Sabatine MS. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA. 2016;316:1289–97.

    Article  CAS  PubMed  Google Scholar 

  • Sniderman AD, Thanassoulis G, Glavinovic T, Navar AM, Pencina M, Catapano A, Ference BA. Apolipoprotein B particles and cardiovascular disease: a narrative review. JAMA Cardiol. 2019;4:1287–95.

    Article  PubMed  PubMed Central  Google Scholar 

  • Toth PP. Subclinical atherosclerosis: what it is, what it means and what we can do about it. Int J Clin Pract. 2008;62:1246–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Victor RG, Haley RW, Willett DL, et al. The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular health. Am J Cardiol. 2004;93:1473–80.

    Article  PubMed  Google Scholar 

  • Virani SS, Brautbar A, Davis BC, et al. Associations between lipoprotein(a) levels and cardiovascular outcomes in black and white subjects: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2012;125:241–9.

    Article  CAS  PubMed  Google Scholar 

  • Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324.

    Article  CAS  PubMed  Google Scholar 

  • Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004;109:II2–10.

    Article  PubMed  Google Scholar 

  • Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Anurag Mehta, Devinder S. Dhindsa & Laurence S. Sperling

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  1. Anurag Mehta
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  2. Devinder S. Dhindsa
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  3. Laurence S. Sperling
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Correspondence to Laurence S. Sperling .

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  1. Section on Cardiovascular Disease, Wake Forest University School of Medicine, Winston Salem, NC, USA

    Michael D. Shapiro

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Mehta, A., Dhindsa, D.S., Sperling, L.S. (2022). Global Approaches to Risk Assessment: The US Guidelines. In: Shapiro, M.D. (eds) Cardiovascular Risk Assessment in Primary Prevention. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-98824-1_2

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  • DOI: https://doi.org/10.1007/978-3-030-98824-1_2

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