Table 4

Summary of Recommendations for Risk Assessment

RecommendationsNHLBI GradeNHLBI Evidence StatementsACC/AHA CORACC/AHA LOE
Assessment of 10-Year Risk of a First Hard ASCVD Event
  • 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.

B (Moderate)N/AIB (4–8)
  • 2. 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.

E (Expert Opinion)N/AIIbC
CQ1: Use of Newer Risk Markers After Quantitative Risk Assessment
  • 1. If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of ≥1 of the following—family history, hs-CRP, CAC score, or ABI—may be considered to inform treatment decision making.

E (Expert Opinion)Appendix 4IIbB (9–17)
  • 2. Routine measurement of CIMT is not recommended in clinical practice for risk assessment for a first ASCVD event.

N (No recommendation for or against)Appendix 4III: No BenefitB (12,16,18)
  • 3. The contribution of ApoB, CKD, albuminuria, and cardiorespiratory fitness to risk assessment for a first ASCVD event is uncertain at present.

N (No recommendation for or against)Appendix 4
CQ2: Long-Term Risk Assessment
  • 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.

B (Moderate)Appendix 5
CQ2/ES7
IIaB (19,20)
  • 2. Assessment of 30-year or lifetime ASCVD risk on the basis of traditional risk factors may be considered in adults 20–59 years of age who are free from ASCVD and are not at high short-term risk.

C (Weak)Appendix 5
CQ2/ES2,
CQ2/ES3,
CQ2/ES4,
CQ2/ES5,
CQ2/ES6
IIbC (20–22)

A downloadable spreadsheet enabling estimation of 10-year and lifetime risk of ASCVD and a Web-based calculator is available at http://my.americanheart.org/cvriskcalculator and http://www.cardiosource.org/en/Science-And-Quality/Practice-Guidelines-and-Quality-Standards/2013-Prevention-Guideline-Tools.aspx.

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 —, not applicable.

  • Derived from the ARIC (Atherosclerosis Risk in Communities) study (8), Cardiovascular Health Study (5), CARDIA (Coronary Artery Risk Development in Young Adults) study (7), and Framingham original and offspring cohorts (4,6).

  • 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.