Calculation of ASCVD Risk
1. Understanding ASCVD Risk: Atherosclerotic cardiovascular disease (ASCVD) risk is calculated to estimate a person's likelihood of experiencing a heart attack, stroke, or cardiovascular death within 10 years. This is crucial for guiding preventive measures and treatment strategies.
2. Recommended Tools for ASCVD Risk Calculation:
- Pooled Cohort Equations (PCE):
- Introduced in the 2013 ACC/AHA guidelines, PCE is the most widely used method for estimating 10-year ASCVD risk in the U.S.
- Includes separate equations for non-Hispanic white and black adults.
- Estimates risk of heart attack, stroke, and cardiovascular death.
- Online Tools:
- American Heart Association: http://my.americanheart.org/
- ACC ASCVD Risk Estimator Plus: https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
- App: https://www.acc.org/ASCVDApp
- ClinCalc.com: https://clincalc.com/cardiology/ascvd/pooledcohort.aspx
- PREVENT Model (2024 Update):
- This newer model calculates both 10-year and lifetime risk, offering a more comprehensive assessment.
- Available on the AHA Risk Calculator 2024.
3. Who Should Use the Risk Calculator?
The ACC/AHA guidelines recommend using the PCE for U.S. adults aged 40–75 years without a history of ASCVD or diabetes to estimate 10-year risk. For individuals with the following conditions, statin therapy is recommended without the need for risk calculation:
- LDL–C ≥ 190 mg/dL
- Diabetes (Type 1 or 2) aged 40–75 years with an estimated 10-year ASCVD risk ≥ 7.5%
- Adults aged >21 years who are candidates for statin therapy
4. Interpreting Results:
- High risk: 10-year ASCVD risk ≥ 10% (considered for preventive therapy)
- Moderate risk: 10-year ASCVD risk 5-7.5% (considered for preventive therapy if LDL-C is high)
- Lower risk: <5% (lower priority for statin therapy unless other risk factors are present)
5. Goals of Treatment: While the risk calculator helps guide treatment decisions, specific goals for treatment (e.g., blood pressure, cholesterol targets) should be individualized based on risk category and overall health. Traditional blood pressure goals were <140/90 mm Hg, but newer guidelines may adjust this based on risk factors.
6. Considerations for Specific Populations:
- Diabetes: Requires separate risk assessment due to higher baseline risk.
- Ethnicity: PCE provides equations for white and black adults, but for other ethnicities, clinical judgment may be needed.
Conclusion: The Pooled Cohort Equations remain the gold standard for 10-year ASCVD risk estimation, with the PREVENT model offering additional insights. Always consult a healthcare provider to interpret results and tailor preventive strategies.
Sources:
- American Heart Association, ACC/AHA guidelines
- ClinCalc.com, Liv Hospital (2024)