Cited by 302Lipoproteins and Cardiovascular HealthHealth Promotion and Cardiovascular PreventionCardiac Imaging and Diagnostics

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Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease

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Lloyd-Jones, Donald M., Braun, Lynne T., Ndumele, Chiadi E., Smith, Sidney C., Sperling, Laurence S., Virani, Salim S., Blumenthal, Roger S.·2019·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2018.11.005

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Abstract

Risk assessment is a critical step in the current approach to primary prevention of atherosclerotic cardiovascular disease. Knowledge of the 10-year risk for atherosclerotic cardiovascular disease identifies patients in higher-risk groups who are likely to have greater net benefit and lower number needed to treat for both statins and antihypertensive therapy. Current U.S. prevention guidelines for blood pressure and cholesterol management recommend use of the pooled cohort equations to start a process of shared decision-making between clinicians and patients in primary prevention. The pooled cohort equations have been widely validated and are broadly useful for the general U.S. clinical population. But, they may systematically underestimate risk in patients from certain racial/ethnic groups, those with lower socioeconomic status or with chronic inflammatory diseases, and overestimate risk in patients with higher socioeconomic status or who have been closely engaged with preventive healthcare services. If uncertainty remains for patients at borderline or intermediate risk, or if the patient is undecided after a patient-clinician discussion with consideration of risk enhancing factors (e.g., family history), additional testing with measurement of coronary artery calcium can be useful to reclassify risk estimates and improve selection of patients for use or avoidance of statin therapy. This special report summarizes the rationale and evidence base for quantitative risk assessment, reviews strengths and limitations of existing risk scores, discusses approaches for refining individual risk estimates for patients, and provides practical advice regarding implementation of risk assessment and decision-making strategies in clinical practice.

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Authors: Lloyd-Jones, D. M., Braun, L. T., Ndumele, C. E., Smith, S. C., Sperling, L. S., Virani, S. S., & Blumenthal, R. S.
ORCID: Braun, Lynne T.
Ndumele, Chiadi E.
Smith, Sidney C.
Sperling, Laurence S.
Virani, Salim S.
Blumenthal, Roger S.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2019-06
Volume: 73
Issue: 24
Pages: 3153-3167
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2018.11.005
OpenAlex: W3137768417
Cited by: 302
References: 84
Citations by year: 2026: 25 · 2025: 54 · 2024: 40 · 2023: 43 · 2022: 44 · 2021: 41 · 2020: 28 · 2019: 26
FWCI: 25.12
Type: journal article
Language: en
Update notices: erratum (2019-06-25)
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 390 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords: atherosclerotic cardiovascular disease, primary prevention, quantitative risk assessment, Pooled Cohort Equations, shared decision-making, statin therapy, antihypertensive therapy, coronary artery calcium, risk reclassification, racial and ethnic disparities, socioeconomic status, chronic inflammatory diseases, family history (medicine), blood pressure control, cholesterol management
MeSH terms: Clinical Decision-Making, Decision Making, Shared, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Primary Prevention, Risk Factors, United States, Risk Assessment, Quality Improvement

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Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease

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