Key Points
Î The ACC/AHA endorses the concept that the intensity of preventive
intervention should be matched to the patient's level of absolute risk. Hence,
quantitative risk assessment is a critical step in efforts to prevent ASCVD.
Î This guideline focuses on the large proportion of the adult population
without clinical signs or symptoms of ASCVD who merit evaluation for the
primary prevention of ASCVD. It does not apply to those with clinically
manifest ASCVD, who require secondary prevention approaches, or to highly
selected patient subgroups, such as those with symptoms suggestive of
CVD, who require diagnostic strategies rather than risk assessment.
Î Furthermore, these recommendations were not developed for use in specific
subgroups of asymptomatic individuals at unusually high risk, such as those
with genetically determined extreme values of traditional risk factors (eg,
patients with familial hypercholesterolemia).
Î Tools enabling estimation of 10-year and lifetime risk for ASCVD and a web-
based calculator are available at http://www.cardiosource.org/en/Science-
And-Quality/Practice-Guidelines-and-Quality-Standards/2013-Prevention-
Guideline-Tools.aspx or http://my.americanheart.org/cvriskcalculator.
Table 2. Expert Opinion Thresholds for Use of Optional
Screening Tests When Risk-Based Decisions Regarding
Initiation of Pharmacological Therapy Are Uncertain
Following Quantitative Risk Assessment
Measure
Supports Revising Risk
Assessment Upward
Does Not Support
Revising Risk Assessment
Family history of premature
CVD
Male <55 years of age
Female <65 years of age
(1st degree relative)
Occurrences at older ages
only (if any)
hs-CRP ≥2 mg/L <2 mg/L
CAC score ≥300 Agatston units or
≥75th percentile for age, sex,
and ethnicity
a
<300 Agatston units and
<75
th
percentile for age, sex,
and ethnicity
a
ABI <0.9 ≥0.9
a
For additional information, see http://www.mesa-nhlbi.org/CACReference.aspx.
Diagnosis
