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New Recommendations for Assessing Cardiovascular Risk in Adults

Heart groups expand 2004 guidelines (November 12)

The American College of Cardiology (ACC) and the American Heart Association (AHA) have released a new clinical practice guideline to help primary care clinicians better identify adults who may be at high risk for developing atherosclerotic cardiovascular disease and who therefore may benefit from lifestyle changes or drug therapy to help prevent it.

The guideline — last updated in 2004 — has been broadened to include assessment for the risk of stroke as well as heart attack, and to provide new gender- and ethnicity-specific formulas for predicting risk in African-American and white women and men. The recommendations also help clinicians and patients look beyond traditional short-term (10-year) risk estimates to predict an individual’s lifetime risk of developing heart disease and of having a stroke.

A primary goal of the new guideline is to help ensure that preventive treatments, including lifestyle changes and drug treatment, are used in those most likely to benefit without undue risk or harm. To do this, the guideline developed risk-assessment methods that use risk factors known to lead to atherosclerosis — such as age, cholesterol levels, blood pressure, smoking, and diabetes — that primary care providers can easily collect. This information is then integrated into a risk score to guide care and to prompt risk discussions with patients.

The report also includes new pooled-cohort risk equations to better represent the effect of atherosclerosis risk factors for specific gender and ethnicities. The authors recommend that the new equations be used to assess risk in non-Hispanic whites and African-Americans 40 to 79 years old.

Further, the guideline provides methods for determining a patient’s lifetime risk that are intended particularly to help younger adults understand how they can reduce their risk for heart disease and stroke.

Sources: AHA; November 12, 2013; and Circulation; November 12, 2013.

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