ASCVD risk tools and the cholesterol guidelines: a quick guide

  • Lloyd-Jones DM & al.
  • J Am Coll Cardiol
  • 3 Nov 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Key points

  • 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. 

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