USPSTF Updates Nontraditional CVD Risk Factor Recommendations

July 11, 2018

The US Preventive Services Task Force (USPSTF) has concluded that the current evidence is insufficient to assess whether the benefits of adding nontraditional risk factors to traditional cardiovascular disease (CVD) risk assessment models outweigh the harms.

Currently, the Framingham Risk Score, Pooled Cohort Equations, or similar CVD risk assessment models are used to inform the modification of risk factors for CVD.


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In order to update their 2009 recommendations, the USPSTF reviewed evidence for the use of nontraditional risk factors including ankle-brachial index (ABI, high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score and whether these additional factors could help to improve measures of calibration, discrimination, and risk reclassification.

Overall, the USPSTF found adequate evidence that adding ABI, hsCRP level, and CAC score to existing CVD risk models resulted in small improvements in discrimination and risk reclassification, but inadequate evidence to assess whether treatment guided by these factors lead to reduced CVD events or mortality.

“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. (I statement)”

—Michael Potts


USPSTF. Risk assessment for cardiovascular disease with nontraditional risk factors [published online July 10, 2018. JAMA. doi:10.1001/jama.2018.8359.