What is the ASCVD risk estimator?

Updated: Nov 30, 2018
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American College of Cardiology/American Heart Association Arteriosclerotic Cardiovascular Disease Risk Estimator

The American College of Cardiology (ACC)/American Heart Association(AHA) Arteriosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, released in 2013, was designed to assess the risk of an initial cardiovascular event and includes participants from racially and geographically diverse cohorts such as the Framingham Heart Study (FHS), the Atherosclerosis Risk in Communities (ARIC) study, the Coronary Artery Risk Development in Young Adults (CARDIA), and the Cardiovascular Health Study (CHS).

The pooled cohort equations predict the future risk of cardiovascular disease and also stroke. The variables used were those used in the 10-year Framingham CVD score, but unlike the Framingham CVD, only hard disease endpoints were used in the calculation. [9]

The accuracy of the 2013 ACC/AHA-ASCVD was called into question very soon after its release when investigators calculated the 10-year risk of cardiovascular events in three large-scale primary prevention cohorts—the Women's Health Study (WHS), the Physicians' Health Study (PHS), and the Women's Health Initiative Observational Study (WHI-OS)—and found that the new algorithm overestimated the risk by 75-150% compared with the actual risk in all three cohorts. [10]

Other studies published in 2014 demonstrated increased risk with the ACC/AHA-ASCVD compared with older risk scores. After analysis of data from National Health and Nutrition Examination Surveys (NHANES) from 2005-2010, investigators predicted that use of the ACC/AHA-ASCVD to calculate risk would result in an increase of 12.8 million individuals eligible for statin therapy largely driven by older patients and treating individuals without cardiovascular disease. Among those aged 60 to 75 years, 87.4% of men and 53.6% of women would now be eligible for lipid-lowering medication, which is up from one-third and 21.2% respectively under the older ATP-III guidelines. [11]

Using the NCDR PINNACLE (National Cardiovascular Data Registry Practice Innovation and Clinical Excellence) data from 2008 to 2012, Maddox and colleagues calculated an increase of 32.4% in patients eligible for statin therapy with use of the ACC/AHA-ASCVD. [12]

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