Research and Literature

Professional Refresher: AHA/ACC Guideline on the Assessment of Cardiovascular Risk: Use of Risk Markers and Long-Term Risk Assessment

January 11, 2017   /

What are these guidelines?
The American Heart Association (AHA) and the American College of Cardiology (ACC) began work in 2008 to compile and transform evidenced-based research and outcomes into doable guidelines to better the heart health of the American people. 

How were the guidelines created?
Work groups, consisting of health professionals and researchers in the field, were formed. Each group looked at a different component of heart health and compiled the best and most relevant research studies and results. These work groups then established guidelines based on the available evidence. 

How can they help my patients?
These guidelines are intended to guide physicians and health professionals to better reduce the risk for cardiovascular events, like heart attacks and high blood pressure, in their patients.  

What are the specific guidelines?
The guidelines on the assessment of cardiovascular risk were divided into 2 components that have been shown to have an effect on assessing cardiovascular risk: 1) Use of Newer Risk Markers After Quantitative Risk Assessment and 2) Long Term Risk Assessment. The guidelines below are copied directly from the report, which can be assessed at http://circ.ahajournals.org/content/129/25_suppl_2/S49.full

  1. Use of Newer Risk Markers After Quantitative Risk Assessment
    1. If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of 1 or more of the following: family history, high-sensitivity C-reactive protein (hs-CRP), coronary artery calcium (CAC) score, or ankle brachial index (ABI), may be considered to inform treatment decision-making.
    2. Routine measurement of carotid intima media thickness (CIMT) is not recommended in clinical practice for risk assessment for a first arteriosclerotic cardiovascular disease (ASCVD) event.
    3. The contribution of apolipoprotein B (ApoB), chronic kidney disease, albuminuria, and cardiorespiratory fitness to risk assessment for a first ASCVD event is uncertain at present.
  2. Long-Term Risk Assessment
    1. It is reasonable to assess traditional ASCVD risk factors every 4 to 6 years in adults 20 to 79 years of age who are free from ASCVD and to estimate 10-year ASCVD risk every 4 to 6 years in adults 40 to 79 years of age who are free from ASCVD.
    2. Assessment of 30-year or lifetime ASCVD risk on the basis of traditional risk factors may be considered in adults 20 to 59 years of age who are free from ASCVD and are not at high short-term risk.

Where should I begin to help my patients?

Health care professionals can help patients pick one guideline and set weekly goals on how to make small, positive changes. A registered dietitian nutritionist (RDN) can develop more specific and individualized plans.

One very simple step in helping patients assess their cardiovascular risk is to use the cardiovascular risk calculator located at http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp. This tool was developed along with these guidelines. 

References and recommended readings
Goff Jr DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Circulation. 2014;129:S-49-S73. doi:10.1161/01.cir,0000437741.48606.98.