From the Guidelines
To compute cardiovascular risk, use the ACC/AHA Pooled Cohort Equations, as recommended by the USPSTF, to calculate the 10-year risk of cardiovascular disease events, taking into account age, sex, race, cholesterol levels, systolic blood pressure, antihypertension treatment, presence of diabetes, and smoking status. This method is supported by the most recent and highest quality study available, which emphasizes the importance of using a reliable risk calculator to estimate patients' cardiovascular risk 1.
Key Factors to Consider
When calculating cardiovascular risk, the following factors should be considered:
- Age
- Sex
- Race
- Cholesterol levels
- Systolic blood pressure
- Antihypertension treatment
- Presence of diabetes
- Smoking status
Risk Assessment and Treatment Recommendations
Risk assessment should be performed for adults aged 40-75 without established cardiovascular disease. Treatment recommendations vary by risk level, with high-risk patients typically needing statin therapy, while intermediate-risk patients may benefit from moderate-intensity statins after discussing risk factors 1.
Regular Reassessment
Regular reassessment every 4-6 years is recommended as risk factors change over time, allowing for adjustments to preventive strategies, including lifestyle modifications and medication decisions 1.
Additional Considerations
Other risk prediction tools, such as the Framingham Risk Score, may also be used, but the ACC/AHA Pooled Cohort Equations are currently the most recommended and widely used method 1. It is essential to choose a risk calculator that suits the local population and to consider the individual's medical history, geographical region, and clinical guidelines when selecting a tool 1.
From the Research
Method to Calculate Cardiovascular Risk
The method to calculate cardiovascular risk involves using specific algorithms that combine information from traditional risk factors, including:
- Blood pressure
- Lipids
- Smoking
- Age
- Sex
- Other factors 2 These algorithms are used to estimate the 10-year risk of cardiovascular disease, with a risk estimate of 20% or higher considered high, and 7.5% to less than 20% considered intermediate 3
Risk Assessment Tools
Several risk assessment tools are available, including:
- The atherosclerotic cardiovascular disease (ASCVD) pooled cohort equations, recommended by the American College of Cardiology/American Heart Association (ACC/AHA) 3
- The AHA's Life's Simple 7, which defines ideal cardiovascular health as no tobacco use, ideal blood pressure, blood glucose, and cholesterol levels, adequate physical activity, weight management, and healthy diet 3
- Novel self-report tools, such as the one developed using data from the Atherosclerosis Risk in Communities cohort, which predicts 10-year risk of incident cardiovascular events using patient-reported information 4
Limitations and Controversies
There are limitations and controversies surrounding the use of cardiovascular risk calculators, including:
- Variability in risk estimates between different calculators 5
- Limited consistency in risk assessment among calculators 5
- The need for primordial prevention, in addition to continued innovation in risk assessment 6
Clinical Application
Cardiovascular risk assessment is fundamental to the prevention of cardiovascular disease, and is used to determine the size of the potential benefits that might accrue to individual patients from use of statins, aspirin, and other preventive interventions 2, 3 Clinicians should discuss the potential benefits of statin therapy for primary prevention in the context of the patient's preferences and values, and consider the use of CVD risk enhancers, such as coronary artery calcium assessed by computed tomography 3