Headed in the Right Direction but at Risk for Miscalculation: A Critical Appraisal of the 2013 ACC/AHA Risk Assessment Guidelines.
J Am Coll Cardiol. 2014 Apr 23;
Authors: Amin NP, Martin SS, Blaha MJ, Nasir K, Blumenthal RS, Michos ED
The newly released 2013 ACC/AHA Guidelines for Assessing Cardiovascular Risk makes significant progress compared to prior cardiovascular risk assessment systems. Its new focus on total atherosclerotic cardiovascular diseases (ASCVD) now includes stroke in addition to hard coronary events and has separate equations to facilitate calculation of risk in non-Hispanic white and black individuals and for women. Physicians may now calculate lifetime risk in addition to10-year risk. Despite this important progress, using the new risk calculators may lead to inaccurate assessment of atherosclerotic cardiovascular risk in special groups such as certain racially diverse populations or younger individuals with unique ASCVD risk factors. Yet in other populations, there appears to be a systematic overestimation of risk. These issues may result in inappropriate preventive management. The guidelines could provide clearer direction on which individuals would benefit from additional testing, such as coronary calcium scores, in order to drive preventive therapies. We applaud the advances of these new guidelines, and we aim to critically appraise the applicability of the risk assessment tools so that further refinement to the calculators can be made in future iterations of these models to more accurately assess patient risk.
PMID: 24814487 [PubMed - as supplied by publisher]