Ascvd Risk Calculator App Download

The American Heart Association and the American College of Cardiology are excited to provide a series of cardiovascular prevention guidelines for the assessment of cardiovascular risk, lifestyle modifications that reduce risk, management of elevated blood cholesterol, and management of increased body weight in adults.

The information required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status.

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The ACC/AHA 2018 Cholesterol Guidelines and 2017 Hypertension Guidelines recommend the use of quantitative 10-year risk assessment, based on measurement of traditional ASCVD risk factors and with use of a validated risk prediction tool, as the first step in considering treatment options for primary prevention. Results of 10-year risk estimation should be communicated through a clinician-patient risk discussion to decide upon the intensity of preventive measures, especially whether to initiate medical therapy.

The estimates of lifetime risk are most directly applicable to non-Hispanic whites. We recommend the use of these values for other race/ethnic groups, though as mentioned above, these estimates may represent under- and overestimates for persons of various ethnic groups. Because the primary use of these lifetime risk estimates is to facilitate the very important discussion regarding risk reduction through lifestyle change, the imprecision introduced is small enough to justify proceeding with lifestyle change counseling informed by these results.

In the National Cholesterol Education Program Adult Treatment Panel III guidelines published in 2001, estimation of cardiovascular risk was recommended based on the Framingham score for 10-year risk of myocardial infarction and the Canadian Cardiovascular Society currently recommends the Framingham total cardiovascular risk score. During development of joint guidelines released in 2013 by the American College of Cardiology (ACC) and American Heart Association (AHA), the decision was taken to develop a new risk score. This resulted in the ACC/AHA Pooled Cohort Equations Risk Calculator. This risk calculator, based on major National Heart, Lung, and Blood Institute-funded cohort studies, is designed to predict 10-year risk of 'hard' atherosclerotic cardiovascular disease (ASCVD) events, namely, nonfatal myocardial infarction, fatal coronary heart disease, nonfatal, or fatal stroke. Considerable strengths are its inclusion of stroke as an end point and race as a characteristic, which allows better risk prediction especially in African-American individuals, plus provision of lifetime ASCVD risk estimates for adults aged 20-59 years. Notable omissions from the risk factors include chronic kidney disease and any measure of social deprivation. An early criticism of the Pooled Cohort Equations Risk Calculator has been its alleged overestimation of ASCVD risk which, if confirmed in the general population, is likely to result in statin therapy being prescribed to many individuals at lower risk than the intended 7.5% 10-year ASCVD risk threshold for treatment in the joint ACC/AHA cholesterol guidelines. In this review we discuss the development of the new risk calculator, its strengths and weaknesses, and potential implications for its routine use.

No cardiovascular risk score has included Latin American patients in its development. The ACC/AHA ASCVD risk score has not been validated in Latin America; consequently, its predictive capacity in the population of the region is unknown. The aim of this study is to evaluate the discrimination capacity and calibration of the ACC/AHA ASCVD score to predict the 10-year risk of a cardiovascular event in a primary prevention cohort followed in a Colombian hospital. A retrospective cohort study was conducted in primary prevention patients belonging to an intermediate/high-risk and low-risk cohort without established atherosclerotic disease. Cardiovascular risk was calculated at inclusion. The calibration was analyzed by comparing observed and expected events in the different risk categories. A discrimination analysis was made using the area under the ROC curve and C statistic. A total of 918 patients were included-202 from the intermediate/high-risk and 716 from the low-risk cohort. The median cardiovascular risk was 3.6% (IQR 1.7-8.5%). At the 10-year follow-up, 40 events (4,4%) occurred. The area under the ROC curve was 0.782 (95% CI 0.71-0.85). The Hosmer-Lemeshow test did not show differences between expected and observed events. The ACC/AHA ASCVD score is calibrated and has good discrimination capacity in predicting 10-year risk of cardiovascular events in a Colombian population.

ASCVD Risk Estimator Plus (Pooled Cohort Equation Risk Score) tools.acc.org/ascvd-risk-estimator-plus. Provides 10-year ASCVD risk estimates for those aged 40-79 and lifetime ASCVD risk estimates for those aged 20-59.

Criteria for Very High Risk Status. Adapted from Grundy et al. (15) Very high-risk status is defined as two or more major ASCVD events or one major ASCVD event and multiple high risk conditions.

Objectives: Cardiovascular diseases (CVDs) occur more often in people living with HIV (PLWH) than in the general population. It has been reported that CVD risk scores developed for the general population underestimate the CVD risk in PLWH. Performances of the Framingham Risk Score (FRS), the Systematic Coronary Risk Evaluation (SCORE) and the atherosclerotic cardiovascular disease (asCVD) risk score in PLWH were compared with the general population to quantify score-specific differences in risk prediction.

Results: The mean ages were 52.9 6.7 and 59.1 7.7 years in the HIVH and HNR studies, respectively. There were fewer incident CVD events in the HNR study than in the HIVH study (CVD_pAD: 3.9% vs. 12.1%; CHD: 2.1% vs. 7.8%; CVD: 3.5% vs. 9.9%). Age- and sex-adjusted CVD risk was greater with increasing FRS, SCORE and asCVD in both cohorts, but the scores performed more accurately in the HNR than in HIVH study (AUCs FRS: 0.71 vs. 0.65; SCORE: 0.70 vs. 0.62; asCVD: 0.74 vs. 0.62).

A 58-year-old man, J.D., with a history of hypertension and tobacco use comes to my office to discuss his laboratory results. J.D. had a lipid panel drawn before the visit and wants to know whether he has high cholesterol. I use the American College of Cardiology/American Heart Association (ACC/AHA) 2013 atherosclerotic cardiovascular disease (ASCVD) risk estimator to evaluate the appropriateness of statin therapy in this patient.1 Based on the calculator's components for race, I ask J.D. whether he identifies as African American, White, or Other.

However, the use of race as a descriptor persists in clinical algorithms designed to aid decision-making in patient care.4 Race is used as a variable in clinical calculators in a variety of many specialties, ranging from predictors of in-hospital heart failure mortality to the likelihood of success of a vaginal birth after a previous cesarean delivery.5,6

The reasons for inclusion of race as a variable in clinical calculators are complex. The designers of the 2013 ACC/AHA calculator described in this case used data from several community-based cohorts that included adults identified as African American or White with at least 12 years of follow-up. Data from other racial and ethnic groups were insufficient, which is why they are not included in the final calculator.1

Using calculators that force physicians to place their patients into one of several non-overlapping racial categories can significantly change clinical management. For example, if the patient in the case scenario is categorized as White, the 10-year ASCVD risk is estimated as 5.8%; if the patient is categorized as Other, it is 9.6%. If the patient is categorized as African American, the ASCVD risk jumps to 17.7%.1

It is unlikely that a professional consensus about the role of race in clinical algorithms will occur in the immediate future. It is also unlikely that researchers can immediately develop acceptable replacements for every algorithm that includes race. Therefore, because many of these calculators remain helpful to physicians, a framework for addressing these complex issues with patients is provided.

There are alternatives to using the 2013 ACC/AHA ASCVD calculator to evaluate the risk of a primary cardiovascular event, but each has strengths and weaknesses. Considering these alternative approaches to risk stratification may be particularly useful for individuals from cohorts that were not studied in the original data sets that contributed to the development of the calculator, including people of Hispanic or Asian descent.

Physicians are encouraged to use their clinical judgment and shared decision-making around pharmacologic prevention of coronary artery disease. In discussions with patients, physicians can address the following risk factors to evaluate those who are at higher risk of cardiovascular events. Some, but not all, of these variables are included in the existing ASCVD calculator.

The ACC/AHA endorses the use of coronary artery calcium scoring in its 2018 guidelines as a tool for risk stratification of patients with intermediate or borderline risk of CVD based on the ASCVD calculator.12 Some authors have proposed including aortic pulse-wave velocity, carotid ultrasonography, and ankle-brachial index evaluation, especially in patients with a family history of early-onset peripheral arterial disease.13

Some proponents of including race in clinical algorithms argue that taking a patient's race into account helps identify individuals at risk of disease and encourages physicians to address that risk appropriately.16 Race may serve as a useful proxy for other risk factors of disease that have a biologic basis. For example, scholars theorize that the experience of racism can lead to chronic stress, which in turn may increase the chances of developing a variety of diseases.17,18 ff782bc1db