What are the ACCF-AHA guidelines for coronary artery disease (CAD) risk assessment?

Updated: Mar 30, 2020
  • Author: F Brian Boudi, MD, FACP; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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In November 2013, The American College of Cardiology (ACC) and the American Heart Association (AHA) released updated risk-assessment guidelines for atherosclerotic cardiovascular disease. Changes and recommendations include the following [72, 1] :

  • Stroke is added to the list of coronary events traditionally covered by risk prediction equations

  • The guidelines focus primarily on the 10-year risk of atherosclerosis-related events; they focus secondarily on the assessment of lifetime risk for adults aged 59 or younger without high shorter-term risk

  • The strongest predictors of 10-year risk are identified as age, sex, race, total cholesterol, high-density lipoprotein cholesterol (HDL-C), blood pressure, blood-pressure treatment status, diabetes, and current smoking status

  • Adjunct formulas for refining risk estimates by gender and race are provided

  • If risk prediction needs to be further sharpened after risk prediction equations have been performed, the guidelines indicate that coronary-artery calcium scores, family history, high-sensitivity C-reactive protein, and the ankle-brachial index can be used

  • The guidelines recommend that statin therapy be considered in individuals whose 10-year atherosclerotic cardiovascular disease event risk is 7.5% or greater

Guidelines from the American Heart Association and the American College of Cardiology (AHA/ACC) recommend use of a revised calculator for estimating the 10-year risk of developing a first atherosclerotic cardiovascular disease (ASCVD) event, which is defined as a nonfatal myocardial infarction, death from coronary heart disease, or stroke (fatal or nonfatal) in a person who was initially free from ASCVD. [72, 1] The calculator incorporates the following risk factors:

  • Sex

  • Age

  • Race

  • Total cholesterol

  • HDL cholesterol

  • Systolic blood pressure

  • Treatment for elevated blood pressure

  • Diabetes

  • Smoking

For patients 20-79 years of age who do not have existing clinical ASCVD, the guidelines recommend assessing clinical risk factors every 4-6 years. For patients with low 10-year risk (< 7.5%), the guidelines recommend assessing 30-year or lifetime risk in patients 20-59 years old.

Regardless of the patient’s age, clinicians should communicate risk data to the patient and refer to the AHA/ACC lifestyle guidelines, which cover diet and physical activity. For patients with elevated 10-year risk, clinicians should communicate risk data and refer to the AHA/ACC guidelines on blood cholesterol and obesity.

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