The American Society for Preventive Cardiology (ASPC) has developed a clinical practice statement for atherosclerotic cardiovascular disease (ASCVD) risk assessment, which was published in the American Journal of Preventive Cardiology.
The goal of the ASPC’s statement is to provide preventive cardiology specialists with guidance and the tools for assessing ASCVD risk. The guidance is intended to supplement current guidelines regarding risk assessment.
The ASPC issued 10 clinical recommendations in its statement.
The foundation of preventive cardiology is assessing a patient’s risk for ASCVD, according to the researchers. Global risk scoring is the first stage of ASCVD risk assessment in primary prevention.
The presence, quantity, or extent of 1 or more risk enhancing factors, including premature family history, persistently increased low-density lipoprotein-cholesterol level, or chronic kidney disease, and severity of certain inflammatory factors can further affect treatment decisions.
Clinicians are advised to take a comprehensive reproductive history in patients with a uterus, from menarche to menopause, including preeclampsia, premature menopause, and autoimmune disease. Race and ethnicity may affect the validity of current risk assessment tools, and specific higher-risk groups may require further preventive therapy. Social health determinants may have independent effects and also should be discussed.
Coronary artery calcification (CAC) testing may be the most useful subclinical atherosclerotic disease screening test, as it provides improvement of risk reclassification vs global risk scoring in most primary prevention groups, including patients with diabetes. CAC testing can be used when making treatment decisions for preventive therapy, including statin and aspirin use.
The Ankle-Brachial Index for evaluating peripheral artery disease can improve risk reclassification beyond global risk scoring. Carotid ultrasound imaging accompanied by carotid plaque assessment also may be used in risk assessment, particularly when CAC scoring is not available.
Among patients who have pre-existing ASCVD, stratifying those with the highest risk for more aggressive treatment is based on a history of multiple major ASCVD events or one major event and multiple high-risk conditions. Also, patients who have recurrent ASCVD events in the short term require even more aggressive risk factor management.
“Ultimately, ASCVD risk assessment remains an inexact science and while it can be useful for assessing risk in populations of subjects, application to the individual patient is still limited,” wrote the researchers. “However, novel emerging methods to incorporate sociodemographic, genetic, clinical, and lifestyle measures will hopefully improve precision for risk prediction for the individual patient.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Wong ND, Budoff MJ, Ferdinand K, et al. Atherosclerotic cardiovascular disease risk assessment: an American Society for Preventive Cardiology clinical practice statement. Am J Prev Cardiol. Published online March 15, 2022. doi: 10.1016/j.ajpc.2022.100335