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Background and Purpose: In tandem with population-level strategies to reduce the incidence of cardiovascular disease, many effective interventions to delay or prevent cardiovascular events in individuals at high risk are currently available; the determination of individual risk is therefore more important than ever. These new guidelines provide recommendations based on findings from several recent studies.
1. A global risk score (e.g., Framingham Risk Score), including results of blood-pressure and cholesterol tests, should be obtained in all asymptomatic adults (Class I recommendation). The guideline authors deem it “reasonable” to begin acquiring global risk scores at a somewhat arbitrary age of 20 years and then every 5 years thereafter.
2. In patients at intermediate risk according to a global risk score, the authors found no benefit of genetic testing, advanced lipid testing, natriuretic-peptide testing, coronary computed tomography angiography, magnetic resonance imaging for the detection of vulnerable plaques, or stress echocardiography.
3. Measuring high-sensitivity C-reactive protein (hsCRP) is recommended in men aged ≥50 or women aged ≥60 to determine if they might benefit from statin therapy for primary prevention (Class IIa). Measuring hsCRP in men aged <50 or women aged <60 may be reasonable in those at intermediate risk (Class IIb).
4. Consistent with other guidelines, hsCRP testing is not recommended for high- or low-risk individuals (Class III).
5. The use of ultrasound measurement of carotid intima–media thickness (CIMT) is reserved for intermediate-risk individuals at well-equipped sites by highly trained operators (Class IIa). Serial measurement of CIMT is not advised, given the lack of a clear process–outcome link.
6. Similarly, the measurement of coronary artery calcium is reserved for intermediate-risk individuals and those aged ≥40 with diabetes (Class IIa). Again, serial testing is not advised, given the lack of a clear process–outcome link.
Greenland P et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2010 Dec 14/21; 56:e50.
Comment
These guidelines emphasize the preeminence of traditional risk factors in determining prognosis; the authors find little evidence for the inclusion of additional risk factors in assessing cardiovascular risk in asymptomatic individuals. Two areas that have been the subject of much recent research, hsCRP and the role of imaging, are addressed in detail. Overall and relative to other international guidelines, these take a fairly conservative stance with respect to the clinical utility of novel biomarkers, genetic testing, and imaging.