Title: 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Date Posted: November 15, 2010
Authors: Greenland P, Alpert JS, Beller GA, et al.
Citation: J Am Coll Cardiol 2010;Nov 15:[Epub ahead of print].
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Perspective:
The following are 10 points to remember about the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults:
1. The ACCF/AHA practice guidelines are intended to assist health care providers in clinical decision making by describing a range of generally acceptable approaches to the diagnosis, management, and prevention of specific diseases or conditions.
2. For any new risk marker to be considered a useful candidate for risk prediction, it must, at the very least, have an independent statistical association with risk after accounting for established readily available and inexpensive risk markers. It should be based on studies that include large numbers of outcome events and with rigorous assessments that include analysis of the calibration, discrimination, and reclassification of the predictive model.
3. Global risk scores (e.g., Framingham or Reynold’s) and family history of atherothrombotic disease should be assessed in all asymptomatic adults.
4. In the absence of inflammatory disorders, C-reactive protein may be useful in men 50 years and women 60 years and older with a low-density lipoprotein cholesterol <130 mg/dl to decide on statin therapy, and those at intermediate risk to further risk stratify. Lipoprotein-associated phospholipase A2 may be useful in intermediate-risk persons.
5. Measurement of glycated hemoglobin may be used in asymptomatic adults without diabetes. Testing for microalbuminuria is reasonable for cardiovascular risk assessment in intermediate-risk and hypertensive and diabetic adults.
6. Echocardiography may be considered to assess for left ventricular hypertrophy in asymptomatic adults with hypertension. A resting electrocardiogram (ECG) can be recommended in adults with hypertension or diabetes, and an exercise ECG may be considered in intermediate-risk asymptomatic adults, particularly in sedentary persons planning to embark on an exercise program.
7. Measurement of coronary artery calcium (CAC) and carotid intima-media thickness may be useful in adults at intermediate risk (10-20%), and CAC can also be helpful in low- to intermediate-risk (6-10%) men and women and diabetics over 40 years old.
8. Stress myocardial perfusion imaging (MPI) may be considered for advanced cardiovascular risk assessment in asymptomatic adults with diabetes, with a strong family history of coronary heart disease, and when other testing suggests high risk, such as a CAC score 400 or greater.
9. There is no evidence in support of the following: measurement of lipoproteins, apolipoproteins, particle size and density; genomic testing; CAC score in very low-risk persons; coronary computed tomography angiography or magnetic resonance imaging of plaque for risk assessment; or stress echo or stress MPI in low- or intermediate-risk asymptomatic adults.
10. Each of the recommendations is weighted based upon the evidence and expert opinion, for which there is always room for disagreement. The 2010 guideline for cardiovascular risk assessment should satisfy the majority of clinical cardiologists and clinicians.
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