Estimation of Risk for Initial Atherosclerotic Cardiovascular Disease Events: Taking Stock and Moving Forward.

Abstract

In 2013, the American College of Cardiology/American Heart Association published guidelines for atherosclerotic cardiovascular disease (ASCVD) risk assessment.1 They recommended that clinicians calculate ASCVD risk for adult patients and based cholesterol treatment recommendations on these estimates. Persons with severe hypercholesterolemia or those known to have ASCVD were considered to be at high risk for clinical ASCVD, and they fell outside the purview of risk assessment. The remainder, which included most middle-age and older Americans with and without diabetes mellitus, were candidates for ASCVD risk assessment. A reasonable interval has elapsed to evaluate the strategy put forward and to contemplate changes that might improve prevention. Critical issues include how well does the current ASCVD algorithm identify persons who subsequently develop ASCVD events, and can they be improved? Should segments of the US population receive more attention? How can the ASCVD risk estimates be augmented? The 2013 guidelines provided new functions to estimate ASCVD risk in a 10-year time frame, applicable to millions of American adults 40 to 79 years of age, and the committee also suggested considering 30-year and lifetime risk.1 Several American longitudinal population studies served as data sources …