Assessment
4
CV Risk Assessment
➤ 1.2 In adults with endocrine disorders, we recommend conducting a CV
risk assessment by evaluating traditional risk factors, including calculation
of 10-year ASCVD risk using a tool such as the Pooled Cohort Equations.
(1|⊕⊕⊕
)
➤ 1.3 In adults with endocrine disorders at borderline or intermediate
risk (10-year ASCVD risk 5%–19.9%), particularly those with additional
risk-enhancing factors, in whom the decision about statin treatment and/
or other preventive interventions is uncertain, we suggest measuring
coronary artery calcium (CAC) to inform shared decision-making.
(2|⊕⊕⊕
)
Technical Remarks:
▶ Borderline and intermediate CV risk are defined as 5%–7.4% and 7.5%–19.9%
10-year ASCVD risk using the Pooled Cohort Equations.
▶ Risk enhancing factors are additional features, including diseases, that enhance
the risk of ASCVD beyond the risk associated with major risk factors and/or the
calculated 10-year risk of ASCVD.
▶ In patients with additional risk-enhancing factors, including elevated Lp(a) as
described below, risk assessment should consider traditional 10-year ASCVD risk
assessment and the presence of risk-enhancing factors. The CAC score should be
considered when risk assessment and treatment decisions remain uncertain.
▶ At present we suggest measuring CAC as the preferred tool for assessment of
subclinical atherosclerosis. Other techniques to assess atherosclerotic burden are being
developed.
▶ CAC=0 marks very low risk of ASCVD. In patients with baseline CAC=0, evidence
suggests that it is reasonable to repeat a CAC scan after 5–7 years in low risk patients,
3–5 years in borderline to intermediate risk patients, and in 3 years for high risk
patients or those with diabetes.
▶ In patients without diabetes or ASCVD and with LDL >70 mg/dL (1.8 mmol/L),
and 10 year ASCVD risk, >7.5%, or 10 year ASCVD risk 5–7.4% plus one or more
risk enhancing factors, or CAC score over the 75th percentile for age, sex, and race, or
CAC score >100, the initiation of a statin, as adjunct to diet and exercise, is advised
after a discussion of the risk/benefit with the patient.
➤ 1.4 In adult patients with a family history of premature ASCVD, or a
personal history of ASCVD or family history of high Lp(a), we suggest
measuring Lp(a) to inform decision making about short-term and lifetime
ASCVD risk and the need to intensify LDL-C–lowering therapy. (2|⊕⊕
)
Technical Remarks:
▶ Lp(a) ≥50 mg/dL (125 nmol/L) enhances risk of ASCVD.
▶ Lp(a) testing does not need to be repeated if it has previously been measured (i.e., in
childhood or early adulthood).
▶ It is not yet known whether reducing Lp(a) reduces ASCVD risk.
