From the Guidelines
Cardiovascular risk assessment is typically performed using a combination of laboratory tests and risk calculators, including the Framingham Risk Score, Reynolds risk score, or Systematic Coronary Risk Evaluation.
Key Laboratory Tests and Risk Calculators
- Global risk score: used to categorize a patient’s risk as low, intermediate, or high risk 1
- Framingham Risk Score (FRS): a widely used risk calculator to estimate the 10-year risk of cardiovascular events 1
- Reynolds risk score: another risk calculator that takes into account additional factors such as family history and inflammation 1
- Systematic Coronary Risk Evaluation: a risk calculator that estimates the 10-year risk of cardiovascular events based on multiple risk factors 1
- Pooled cohort risk calculator: a risk calculator that estimates the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) 1
Additional Tests for Risk Assessment
- Coronary artery calcium (CAC) score: a validated measure of overall coronary atherosclerotic burden, which can be used as a risk modifier in asymptomatic subjects 1
- Carotid artery ultrasound: may be considered as a risk modifier in the cardiovascular risk assessment of asymptomatic subjects 1
- Ankle-brachial index (ABI): may be considered as a risk modifier in cardiovascular risk assessment 1
- Exercise ECG: may be considered for cardiovascular risk assessment in asymptomatic adults, particularly when attention is paid to non-ECG markers such as exercise capacity 1
Important Considerations
- Family history: assessment of family history of premature cardiovascular disease is recommended as part of cardiovascular risk assessment 1
- Diabetes: persons with diabetes can be considered at a level of risk similar to a patient with established cardiovascular disease 1
- Risk factor assessment: regular assessment of risk factors such as age, sex, smoking status, blood pressure, total and LDL cholesterol, HDL cholesterol, and diabetes is important for cardiovascular risk assessment 1
From the Research
Laboratory Tests for Cardiovascular Risk Assessment
The following laboratory tests are used for cardiovascular risk assessment:
- Blood testing for total cholesterol 2
- Blood testing for HDL-cholesterol 3
- Blood pressure measurement 2, 4
- Measurement of systolic blood pressure 2
- Smoking status assessment 2
- Reported diabetes status assessment 2
- Current treatment for hypertension assessment 2
Non-Laboratory-Based Risk Assessment
Non-laboratory-based risk assessment models can be as accurate as laboratory-based models in predicting cardiovascular disease risk:
- A study found that a non-laboratory-based model that used body-mass index instead of cholesterol was as accurate as a laboratory-based model in predicting cardiovascular events 2
- Another study developed a simplified non-laboratory cardiovascular disease risk assessment chart that was as accurate as a laboratory-based chart in predicting fatal and non-fatal CVD events 5
- Non-laboratory-based risk assessment can be useful in primary CVD prevention as a substitute for laboratory-based assessments or as the initial component of a multistage approach 6
Point-of-Care Testing
Point-of-care testing lipid analysers can be used to screen target populations to identify individuals at high risk of developing cardiovascular disease:
- A study evaluated the performance of two point-of-care testing lipid analysers, Cholestech LDX and CardioChek PA, against laboratory methods in CVD risk assessment 3
- The study found that the Cholestech LDX correctly identified all subjects classified as high risk by the three risk algorithms, while the CardioChek PA failed to identify some high-risk subjects 3
Cost-Effectiveness of Non-Laboratory-Based Risk Assessment
Non-laboratory-based risk assessment can be a cost-effective approach:
- A study found that multistage strategies that used non-laboratory-based risk assessment had incremental cost-effectiveness ratios of $52,000/QALY and $83,000/QALY for men and women, respectively 6
- The study also found that single-stage/non-laboratory-based and multistage approaches had predictive power comparable with Framingham risks, while avoiding 25% to 75% of laboratory testing used in CVD risk screening 6