From the Guidelines
No, you should not check "yes" for smoking status on the ASCVD risk calculator if the patient is a former smoker who has quit, as the risk of heart failure and death for most former smokers is similar to that of never smokers after >15 years of tobacco cessation. The ASCVD risk calculator only considers current smoking status, defined as smoking cigarettes within the last month [ 1 ]. Former smokers should be marked as "no" regardless of how recently they quit or how long they smoked previously. This distinction is important because the risk calculator was designed to assess current cardiovascular risk factors, and smoking cessation significantly reduces cardiovascular risk over time [ 1 ]. The acute effects of smoking on cardiovascular risk begin to diminish shortly after quitting, though the complete normalization of risk may take years.
Key Points to Consider
- The ASCVD risk calculator is designed to assess current cardiovascular risk factors [ 1 ]
- Smoking cessation significantly reduces cardiovascular risk over time [ 1 ]
- Former smokers should be marked as "no" on the ASCVD risk calculator, regardless of how recently they quit or how long they smoked previously
- Current smoking is a major ASCVD risk factor, and cessation can significantly improve the overall ASCVD risk score [ 1 ]
Clinical Implications
When counseling patients, it's worth noting that smoking cessation represents one of the modifiable risk factors that can significantly improve their overall ASCVD risk score. The ASCVD risk calculator should only consider current smoking status, and former smokers should be classified as non-smokers. This approach ensures that the risk score accurately reflects the patient's current cardiovascular risk profile rather than their historical risk factors [ 1 ].
From the Research
ASCVD Risk Score and Prior Smoking Status
- The ASCVD risk score is used to assess the risk of atherosclerotic cardiovascular disease, and it takes into account various factors, including smoking status 2.
- According to a study published in JAMA Cardiology, former heavy smokers may have a higher ASCVD risk than never smokers for up to 16 years after smoking cessation 3.
- The study suggests that including former smoking status, pack-years, and years since quitting in the ASCVD risk prediction model can improve risk prediction 3.
- Another study published in the American Journal of Preventive Cardiology emphasizes the importance of assessing baseline ASCVD risk using global risk scores and considering additional risk-enhancing factors, including smoking history 2.
- While the studies do not provide a direct answer to whether to check "yes" on the ASCVD risk score for a prior smoker, they suggest that smoking history is an important factor in assessing ASCVD risk 2, 3.
Implications for Clinical Practice
- Clinicians should consider a patient's smoking history when assessing their ASCVD risk 2, 3.
- The ASCVD risk prediction model should take into account former smoking status, pack-years, and years since quitting to improve risk prediction 3.
- Smoking cessation is crucial in reducing the risk of ASCVD, and clinicians should provide guidance and support to patients who are trying to quit smoking 4, 5.