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When Does Primary Prevention Encroach on Secondary Prevention?
Matthew R Deshotels1, Prasanti Alekhya Kotta1, Juan Simon Rico Mesa1
1Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Insights
Certain individuals in primary prevention have atherosclerotic cardiovascular disease (ASCVD) risks similar to those in secondary prevention. Coronary artery calcium (CAC) scores can identify these high-risk primary prevention patients for better risk mitigation.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Primary prevention of atherosclerotic cardiovascular disease (ASCVD) typically involves lower risk than secondary prevention.
- A spectrum of risk exists within primary prevention, with some individuals approaching secondary prevention risk levels.
Purpose of the Study:
- To review clinical conditions where primary prevention ASCVD risk mirrors secondary prevention risk.
- To identify high-risk individuals within primary prevention cohorts.
Main Methods:
- Review of clinical conditions and risk stratification strategies in ASCVD prevention.
- Analysis of coronary artery calcium (CAC) scoring for risk assessment in primary prevention.
Main Results:
- Coronary artery calcium (CAC) scores ≥300 AU indicate ASCVD event rates comparable to secondary prevention populations.
- CAC scores ≥1,000 AU are associated with ASCVD risks seen in very high-risk secondary prevention groups.
- Current guidelines may not fully capture the high-risk status of certain primary prevention patients.
Conclusions:
- Identifying primary prevention patients with ASCVD risk equivalent to secondary prevention is crucial.
- Utilizing tools like CAC scoring can enable more precise risk stratification and targeted mitigation strategies.
- Tailoring interventions based on individual risk profiles improves ASCVD prevention outcomes.
Purpose Of Review:
The risk of incident atherosclerotic cardiovascular disease (ASCVD) in primary prevention is typically lower than in secondary prevention. However, there is a spectrum of risk among individuals undergoing primary prevention with the risk in some individuals approaching those of secondary prevention. We review the clinical conditions wherein the risk in primary prevention is similar to that observed in secondary prevention.
Recent Findings:
Among individuals without established ASCVD, coronary artery calcium (CAC) scores ≥ 300 AU are associated with ASCVD event rates similar to secondary prevention populations. CAC score ≥ 1,000 AU are associated with an ASCVD risk seen in very high-risk secondary prevention populations. Interpretation of these observations must however consider differences in the risk reduction strategies. Current guidelines dichotomize ASCVD prevention into primary and secondary prevention, but certain primary prevention patients have an ASCVD risk equivalent to that of secondary prevention populations. Identifying higher risk primary prevention populations will allow for better risk mitigation strategies.
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