What is the Atherosclerotic Cardiovascular Disease (ASCVD) score?

From the Guidelines

The ASCVD score should be calculated for all asymptomatic adults 40 to 75 years of age to estimate their 10-year risk of developing cardiovascular disease, using factors such as age, gender, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure treatment status, diabetes status, and smoking status, as recommended by the 2019 ACC/AHA guideline 1. To calculate the ASCVD score, healthcare providers can use the race- and sex-specific PCE (ASCVD Risk Estimator) to estimate 10-year ASCVD risk. The score is categorized into four groups: low risk (<5%), borderline risk (5-7.4%), intermediate risk (7.5-19.9%), and high risk (≥20%) 1.

• The ASCVD score helps guide treatment decisions, particularly regarding statin therapy, with high-intensity statins recommended for high-risk individuals and moderate-intensity statins for intermediate risk individuals 1.
• For those with elevated risk, lifestyle modifications like regular exercise, heart-healthy diet, smoking cessation, and weight management are recommended.
• Additionally, medication therapy with statins may be prescribed based on risk level, with consideration of "risk enhancers" such as family history of premature ASCVD, chronic inflammatory disease, or South Asian ancestry 1.
• The ASCVD score is valuable because it uses multiple factors to create a personalized risk assessment rather than looking at individual risk factors in isolation, allowing for more targeted preventive strategies 1.
• It is also important to note that the PCE may not be suitable for all populations, and alternative risk prediction tools such as the Framingham CVD risk score or the SCORE (Systematic COronary Risk Evaluation) may be used in certain cases 1.

From the Research

ASCVD Score Overview

• The ASCVD score is used to assess the risk of atherosclerotic cardiovascular disease (ASCVD) in individuals, taking into account various risk factors such as blood pressure, lipid profile, and blood glucose levels 2.
• The score is calculated based on global risk scores, which are derived from standard office-based measures, and can be further refined using additional "risk enhancing" factors, including traditional risk factors and novel biomarkers 2.

Risk Assessment and Management

• Accurate ASCVD risk assessment is crucial for targeting preventive therapies and reducing ASCVD risk 2.
• Individuals at low risk are generally recommended for lifestyle management only, while those at highest risk are recommended for both lifestyle and pharmacologic therapy 2.
• The use of statins and angiotensin-converting enzyme (ACE) inhibitors has been shown to be effective in reducing ASCVD risk, particularly in individuals with hypertension and lipid disorders 3, 4.
• PCSK9 inhibitors, a new class of lipid-lowering therapies, have also been shown to be effective in reducing ASCVD risk, particularly in high-risk individuals who are not achieving treatment goals on a maximum tolerated dose of a statin and ezetimibe 5.

Lifestyle Management and Prevention

• Lifestyle management, including a heart-healthy dietary pattern, sodium restriction, and regular physical activity, is recommended as the first priority for primary prevention of ASCVD and type 2 diabetes mellitus (T2DM) 6.
• Individuals with excess weight should aim for a loss of ≥5% of initial body weight in the first year, and behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers 6.
• Regular screening and identification of individuals at metabolic risk, including measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose, is essential for early detection and prevention of ASCVD and T2DM 6.