- This guide to tools for assessing atherosclerotic cardiovascular disease (ASCVD) risk is a companion piece to the new cholesterol guidelines.
- It offers a rundown on refining risk for each patient, putting the person in personalized medicine.
Why this matters
- The new guidelines call for combining conventional risk assessment with “risk enhancement” factors, such as ethnicity, and co-occurring conditions, such as diabetes.
- Available risk tools
- Framingham and PCEs have similar general applicability.
- Reynolds Risk Score shows better performance vs PCE in high socioeconomic status (SES) or lower-risk groups; adds revascularization as endpoint.
- Alignment of Framingham, Reynolds for nonwhite patients or reclassification with coronary artery calcification score, as per new cholesterol guidelines, is uncertain.
- Risk score performance for younger adults (
- For older adults (>75 years), scores perform poorly.
- PCE could overestimate risk for East Asian or Hispanic-white patients but underestimate for South Asian populations; the new guidelines distinguish ethnicity as a “risk enhancer.”
- Per new guidelines, risk assessment is not needed for patients requiring secondary prevention, with familial hypercholesterolemia, or with diabetes (except to determine dosing intensity); these patients can begin statins.