From the Guidelines
A high atherosclerotic cardiovascular disease (ASCVD) 10-year risk score is generally considered to be 7.5% or higher, as indicated by the 2019 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1. This threshold is a critical clinical decision point for guiding preventive treatment strategies, particularly regarding statin therapy. The ASCVD risk calculator incorporates multiple factors, including age, gender, race, total cholesterol, HDL cholesterol, blood pressure, diabetes status, and smoking status, to generate a personalized risk assessment. Some key points to consider in the assessment of ASCVD risk include:
- Risk scores between 7.5% and 20% are typically classified as intermediate-high risk, while scores above 20% are considered high risk 1.
- For patients with scores of 7.5% or higher, moderate to high-intensity statin therapy is frequently recommended, along with lifestyle modifications 1.
- The 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults also emphasizes the importance of estimating 10-year ASCVD risk using the Pooled Cohort Equations 1.
- Understanding your ASCVD risk score helps healthcare providers develop appropriate preventive strategies tailored to your specific cardiovascular risk profile. It's worth noting that the 2019 guideline provides more detailed information on the management of blood cholesterol and the use of statin therapy in primary prevention, and is considered a higher quality study due to its more recent publication year and prestigious journal 1.
From the Research
Atherosclerotic Cardiovascular Disease 10-Year Risk Score
- A high 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is generally considered to be 20% or greater 2
- Patients with a 10-year risk of 7.5% to less than 20% may undergo coronary artery calcium scoring to determine their risk level, and if the coronary artery calcium score is 300 or more Agatston units, the patient can be up-classified to high risk 2
- The American College of Cardiology/American Heart Association Pooled Cohort Equation is used to estimate 10-year ASCVD risk, and this score can help identify patients who are likely to benefit from statin therapy or other preventive measures 3, 4
- Risk assessment is a critical step in primary prevention of ASCVD, and knowledge of the 10-year risk can help guide decision-making between clinicians and patients 4
- The pooled cohort equations may systematically underestimate risk in certain patient populations, such as those from certain racial/ethnic groups or with chronic inflammatory diseases, and overestimate risk in others, such as those with higher socioeconomic status or who have been closely engaged with preventive healthcare services 4