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A perspective on the New American College of Cardiology/American Heart Association guidelines for cardiovascular risk
Iftikhar J Kullo1, Jorge F Trejo-Gutierrez2, Francisco Lopez-Jimenez1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Insights
The new ACC/AHA guidelines offer updated atherosclerotic cardiovascular disease (ASCVD) risk assessment tools. Recommendations include family history, imaging for intermediate risks, and advanced biomarkers to improve cardiovascular risk prediction.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- The American College of Cardiology (ACC)/American Heart Association (AHA) recently released new guidelines for cardiovascular risk assessment.
- These guidelines introduce updated equations for estimating 10-year and lifetime atherosclerotic cardiovascular disease (ASCVD) risk.
- The guidelines incorporate stroke as a key adverse cardiovascular outcome and highlight the importance of shared decision-making.
Purpose of the Study:
- To provide a perspective on the new ACC/AHA guidelines for cardiovascular risk assessment.
- To identify novel aspects, controversial points, and potential adaptations of the guidelines.
- To suggest research directions for improving ASCVD risk assessment.
Main Methods:
- Review of the recently published ACC/AHA guidelines for cardiovascular risk assessment.
- Analysis of the new risk equations and their applicability.
- Discussion of adjuncts for refining risk estimates beyond the guideline recommendations.
Main Results:
- The guidelines offer a framework for ASCVD risk estimation, including specific populations and outcomes.
- Recommendations include integrating family history and considering imaging for subclinical disease in intermediate-risk patients.
- Advanced biomarkers like lipoprotein(a) and imaging techniques like carotid ultrasonography may enhance risk stratification.
Conclusions:
- The new guidelines provide a valuable, adaptable framework for cardiovascular risk assessment.
- Integrating family history, imaging, and advanced biomarkers can refine ASCVD risk estimation.
- Further research is crucial to enhance the performance of ASCVD risk algorithms and improve patient outcomes.
Abstract:
The recently published American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for cardiovascular risk assessment provide equations to estimate the 10-year and lifetime atherosclerotic cardiovascular disease (ASCVD) risk in African Americans and non-Hispanic whites, include stroke as an adverse cardiovascular outcome, and emphasize shared decision making. The guidelines provide a valuable framework that can be adapted on the basis of clinical judgment and individual/institutional expertise. In this review, we provide a perspective on the new guidelines, highlighting what is new, what is controversial, and potential adaptations. We recommend obtaining family history of ASCVD at the time of estimating ASCVD risk and consideration of imaging to assess subclinical disease burden in patients at intermediate risk. In addition to the adjuncts for ASCVD risk estimation recommended in the guidelines, measures that may be useful in refining risk estimates include carotid ultrasonography, aortic pulse wave velocity, and serum lipoprotein(a) levels. Finally, we stress the need for research efforts to improve assessment of ASCVD risk given the suboptimal performance of available risk algorithms and suggest potential future directions in this regard.
