Assessment of cardiovascular risk: Difference between revisions

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Latest revision as of 14:33, 31 October 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk^[1]

Summary of Recommendations for Risk Assessment of Cardiovascular Risk

Implementation of Risk Assessment Work Group Recommendations

Assessment of 10-Year Risk of a First Hard ASCVD Event

Class I
"1. The race- and sex-specific Pooled Cohort Equations* to predict 10-year risk of a first hard ASCVD event should be used in non-Hispanic African Americans and non-Hispanic whites, 40–79 years of age.(Level of Evidence: B)"

Class IIb
"1. Assessment of 10-Year Risk of a First Hard ASCVD Event Use of the sex-specific Pooled Cohort Equations for non-Hispanic whites may be considered for estimation of risk in patients from populations other than African Americans and non-Hispanic whites. (Level of Evidence: C)"

Use of Newer Risk Markers After Quantitative Risk Assessment

Class III†
"1.Routine measurement of CIMT is not recommended in clinical practice for risk assessment for a first ASCVD event. (Level of Evidence: B) "

Class IIb†
"1.If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of ≥1 of the followingdfamily history, hs-CRP, CAC score, or ABIdmay be considered to inform treatment decision making. (Level of Evidence: B)"

Long-Term Risk Assessment

Class IIa
"1. It is reasonable to assess traditional ASCVD risk factors‡ every 4–6 years in adults 20–79 years of age who are free from ASCVD and to estimate 10-year ASCVD risk every 4–6 years in adults 40–79 years of age who are free from ASCVD.(Level of Evidence: B)"

Class IIb
"3. Assessment of 30-year or lifetime ASCVD risk on the basis of traditional risk factorsz may be considered in adults 20–59 years of age who are free from ASCVD and are not at high short-term risk. (Level of Evidence: C)"

^{*Derived from the ARIC (Atherosclerosis Risk in Communities) study, Cardiovascular Health Study , CARDIA (Coronary Artery Risk Development in Young Adults) study , and Framingham original and offspring cohorts
†Based on new evidence reviewed during ACC/AHA update of evidence
‡Age, sex, total cholesterol, high-density lipoprotein cholesterol, systolic BP, use of antihypertensive therapy, diabetes, and current smoking.
ABI indicates ankle-brachial index; ACC, American College of Cardiology; AHA, American Heart Association; ApoB, apolipoprotein B; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CAC, coronary artery calcium; CIMT, carotid intima-media thickness; CKD, chronic kidney disease; COR, Class of Recommendation; CQ, critical question, ES, evidence statement; hs-CRP, high-sensitivity C-reactive protein; LOE, Level of Evidence; NHLBI, National Heart, Lung, and Blood Institute; and d, not applicable.}

References

↑ 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. http://ac.els-cdn.com/S0735109713060312/1-s2.0-S0735109713060312-main.pdf?_tid=b1900316-9d1f-11e6-92c8-00000aacb360&acdnat=1477667193_f8c7920ce856f2c1fa93cb7968f1cb92 Accessed on October 28, 2016

Template:WikiDoc Sources

[Risk-assessment-cardi-1] 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. http://ac.els-cdn.com/S0735109713060312/1-s2.0-S0735109713060312-main.pdf?_tid=b1900316-9d1f-11e6-92c8-00000aacb360&acdnat=1477667193_f8c7920ce856f2c1fa93cb7968f1cb92 Accessed on October 28, 2016

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
+{{Atherosclerosis}}
 {{CMG}}
+==2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk<ref name=Risk-assessment-cardi> 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. http://ac.els-cdn.com/S0735109713060312/1-s2.0-S0735109713060312-main.pdf?_tid=b1900316-9d1f-11e6-92c8-00000aacb360&acdnat=1477667193_f8c7920ce856f2c1fa93cb7968f1cb92 Accessed on October 28, 2016</ref>==
-==Summary of Recommendations for Risk Assessment of Cardiovascular Risk==
+===Summary of Recommendations for Risk Assessment of Cardiovascular Risk===
+====Implementation of Risk Assessment Work Group Recommendations====
+[[Image:Untitled Diagram.png|Implementation of Risk Assessment Work Group Recommendations|800px|center|thumb]]
+====Assessment of 10-Year Risk of a First Hard ASCVD Event====
 {|class="wikitable" width="80%"
 |-
@@ Line 10: / Line 14: @@
 | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1. '''The race- and sex-specific Pooled Cohort Equations* to predict 10-year risk of a first hard ASCVD event should be used in non-Hispanic African
 Americans and non-Hispanic whites, 40–79 years of age.''([[ACC AHA guidelines classification scheme#Classification of Recommendations|Level of Evidence: B]])''<nowiki>"</nowiki>
+|}
+{|class="wikitable" width="80%"
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
+|-
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1. '''Assessment of 10-Year Risk of a First Hard ASCVD Event
+*Use of the sex-specific Pooled Cohort Equations for non-Hispanic whites may be considered for estimation of risk in patients from populations other than African Americans and non-Hispanic whites. ''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: C'']])''<nowiki>"</nowiki>
 |}
+====Use of Newer Risk Markers After Quantitative Risk Assessment====
 {|class="wikitable" width="80%"
 |-
-| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III†]]
-|-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1. '''CQ2: Long-Term Risk Assessment
-*It is reasonable to assess traditional ASCVD risk factorsz every 4–6 years in adults 20–79 years of age who are free from ASCVD and to estimate 10-year ASCVD risk every 4–6 years in adults 40–79 years of age who are free from ASCVD.''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: B'']])''<nowiki>"</nowiki>
 |-
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''Routine measurement of CIMT is not recommended in clinical practice for risk assessment for a first ASCVD event. ''([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']]) ''<nowiki>"</nowiki>
 |}
 {|class="wikitable" width="80%"
 |-
-| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb†]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1. '''Assessment of 10-Year Risk of a First Hard ASCVD Event
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of ≥1 of the followingdfamily history, hs-CRP, CAC score, or ABIdmay be considered to inform treatment decision making. ''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: B'']])''<nowiki>"</nowiki>
-*Use of the sex-specific Pooled Cohort Equations for non-Hispanic whites may be considered for estimation of risk in patients from populations other than African Americans and non-Hispanic whites. ''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: C'']])''<nowiki>"</nowiki>
+|}
+====Long-Term Risk Assessment====
+{|class="wikitable" width="80%"
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2. '''CQ1: Use of Newer Risk Markers After Quantitative Risk Assessment†
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
-*If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of ≥1 of the followingdfamily history, hs-CRP, CAC score, or ABIdmay be considered to inform treatment decision making. ''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: B'']])''<nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3. '''CQ2: Long-Term Risk Assessment
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1. '''It is reasonable to assess traditional ASCVD risk factors‡ every 4–6 years in adults 20–79 years of age who are free from ASCVD and to estimate 10-year ASCVD risk every 4–6 years in adults 40–79 years of age who are free from ASCVD.''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: B'']])''<nowiki>"</nowiki>
-*Assessment of 30-year or lifetime ASCVD risk on the basis of traditional risk factorsz may be considered in adults 20–59 years of age who are free from ASCVD and are not at high short-term risk. ''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: C'']])''<nowiki>"</nowiki>
 |-
 |}
@@ Line 38: / Line 49: @@
 {|class="wikitable" width="80%"
 |-
-| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III‡]]
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
+|-
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3. '''Assessment of 30-year or lifetime ASCVD risk on the basis of traditional risk factorsz may be considered in adults 20–59 years of age who are free from ASCVD and are not at high short-term risk. ''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: C'']])''<nowiki>"</nowiki>
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''CQ1: Use of Newer Risk Markers After Quantitative Risk Assessment
-*Routine measurement of CIMT is not recommended in clinical practice for risk assessment for a first ASCVD event. ''([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']]) ''<nowiki>"</nowiki>
 |}
-*CQ1: Use of Newer Risk Markers After Quantitative Risk Assessment
-**The contribution of ApoB, CKD, albuminuria, and cardiorespiratory fitness to risk assessment for a first ASCVD event is uncertain at present (No recommendation for or against)
 <sup>*Derived from the ARIC (Atherosclerosis Risk in Communities) study, Cardiovascular Health Study , CARDIA (Coronary Artery Risk Development in Young Adults) study , and Framingham original and offspring cohorts<br>†Based on new evidence reviewed during ACC/AHA update of evidence<br>‡Age, sex, total cholesterol, high-density lipoprotein cholesterol, systolic BP, use of antihypertensive therapy, diabetes, and current smoking.
@@ Line 55: / Line 65: @@
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