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Cardiovascular Disease, Risk Assessment With Nontraditional Risk Factors, 2018

* Indicates an old grade definition


Recommendations: Cardiovascular Disease: Risk Assessment With Nontraditional Risk Factors

  • Cardiovascular Disease, Risk Assessment With Nontraditional Risk Factors -- Adults
    Grade: I
    Specific Recommendations:

      The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, or coronary artery calcium (CAC) score to traditional risk assessment for cardiovascular disease (CVD) in asymptomatic adults to prevent CVD events.

       

      See the Clinical Considerations section for suggestions for practice regarding the I statement.


  • Rationale:

    Importance

    Cardiovascular disease is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms.

    Detection

    The USPSTF found adequate evidence that adding the ABI, hsCRP level, or CAC score to existing CVD risk assessment models (Framingham Risk Score [which estimates a person’s 10-year risk of coronary heart disease] or Pooled Cohort Equations [which estimate 10-year risk of myocardial infarction, death from coronary heart disease, or stroke]) may improve calibration (agreement between observed and predicted outcomes), discrimination (ability to distinguish between people who will and will not experience an event), and reclassification (ability to correctly reassign people into clinically meaningful risk strata ). The USPSTF chose to review these 3 nontraditional risk factors because prior evidence reviews identified them as the most promising to improve on existing CVD risk assessment tools.

    Benefits of Risk Assessment and Intervention

    The USPSTF found inadequate evidence to assess whether treatment decisions guided by ABI, hsCRP level, or CAC score test results, when added to existing CVD risk assessment models, lead to reduced incidence of CVD events or mortality.

    Harms of Risk Assessment and Intervention

    The USPSTF found adequate evidence to bound the harms of risk assessment and intervention as small. When direct evidence is limited, absent, or restricted to select populations or clinical scenarios, the USPSTF may place conceptual upper or lower bounds on the magnitude of benefit or harms. Harms can include abnormal test results, inappropriate risk reclassification, and incidental findings leading to additional testing and possible procedures, as well as anxiety.

    USPSTF Assessment

    The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP level, or CAC score to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events.

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