ACC GUIDELINES Bundle

Cardiovascular Risk Assessment

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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

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