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Assessment of cardiovascular disease risk: a 2023 update
Earl Goldsborough1, Erfan Tasdighi2, Michael J Blaha2
1Johns Hopkins University School of Medicine.
Insights
Current best practices for atherosclerotic cardiovascular disease (CVD) risk evaluation emphasize coronary artery calcium (CAC) scoring and lipoprotein(a) [Lp(a)] levels. These tools enhance risk stratification and guide lipid-lowering therapy decisions.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Diagnostics
Background:
- Atherosclerotic cardiovascular disease (CVD) risk assessment traditionally relies on established risk factors.
- Emerging tools offer improved precision in identifying individuals at high risk.
- Optimizing risk assessment is crucial for effective preventive strategies.
Conclusions:
- Lp(a) and CAC scoring are pivotal in refining CVD risk assessment and guiding LLT.
- Future risk assessment may incorporate polygenic risk scoring (PRS) to determine optimal timing for CAC scoring.
- Advanced imaging and PRS hold promise for personalized preventive cardiology strategies.
Purpose Of Review:
The aim of this study was to highlight the current best practice for atherosclerotic cardiovascular disease (CVD) risk evaluation, including selective use of adjunctive tools for risk stratification [e.g. coronary artery calcium (CAC) scoring] and risk enhancement [e.g. lipoprotein(a) [Lp(a)], polygenic risk scoring (PRS)].
Recent Findings:
New studies have evaluated the efficacy of various risk assessment tools. These studies demonstrate the role of Lp(a) as a risk-enhancing factor ready for more widespread use. CAC is the gold standard method of assessing subclinical atherosclerosis, enabling true risk stratification of patients, and informing net benefit assessment for initiating or titrating lipid-lowering therapy (LLT).
Summary:
Lp(a) concentration and CAC scoring, apart from the traditional risk factors, add the most value to the current CVD risk assessment approaches of all available tools, especially in terms of guiding LLT. In addition to new integrative tools such as the MESA CHD Risk Score and Coronary Age calculator, the future of risk assessment may include PRS and more advanced imaging techniques for atherosclerosis burden. Soon, polygenic risk scoring may be used to identify the age at which to begin CAC scoring, with CAC scores guiding preventive strategies.
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