This algorithm was published late 2013 by The American Heart Association and the American College of Cardiology. It includes a Cardiac Risk Algorithm for adult patients w/o known Cardiovascular disease between 40-79 years old that includes assessments of 10-year and lifetime cardiac risks.
Current guidelines for the treatment of cholesterol to reduce cardiovascular risk recommend that the following four groups of patients will benefit from moderate- or high-intensity statin therapy:
- Patients with clinical Cardiovascular disease
- Patients with primary elevations of LDL ≥ 190 mg/dL
- Patients 40 to 75 years of age with diabetes and an LDL 70 to 189 mg/dL without clinical ASCVD
- Patients without clinical Cardiovascular disease or diabetes who are 40 to 75 years of age with LDL 70 to 189 mg/dL and a 10-year Cardiovascular disease risk of 7.5% or higher
Abbreviations: AA = African American; ASCVD = Atherosclerotic cardiovascular disease, defined as CHD death, nonfatal myocardial infarction, or fatal or nonfatal stroke; F = Female; M = Male; N = No; WH = White; Y = Yes.
*This is the lifetime ASCVD risk for an individual at age 50 years with your risk factor levels. In rare cases, 10-year risks may exceed lifetime risks given that the estimates come from different approaches. While 10-year risk estimates are derived from methods and data using continuous variables, the reported estimate of lifetime risk is based on assigning each person into one of 5 mutually exclusive sex-specific groups, as per Lloyd-Jones et al., Circulation 2006; 113(6):791-8. Within each of the 5 groups, each person receives the same lifetime risk estimate. In other words, using this approach, there are only 5 possible lifetime risk estimates reported for men and only 5 possible lifetime risk estimates reported for women. In some cases, the average risk for the group will underestimate the individual’s true lifetime risk. This feature of lifetime risk estimation will result in the estimated lifetime risk being less than the estimated 10-year risk. In these cases, the 10-year risk should be the primary focus for the risk discussion and risk reduction efforts. As further data becomes available and incorporated and methods mature, lifetime risk estimates based on continuous variables will be possible.
For patients and the public: *This is the lifetime risk of cardiovascular diseases, including stroke, for an individual at age 50 years with your risk factor levels. In rare cases, 10-year risks may exceed lifetime risks given that the estimates come from different mathematical approaches. If this is the case, the 10-year risk should be the primary focus for your risk discussion with your provider and for your efforts to reduce your risk.
References:
- 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. doi: 10.1161/01.cir.0000437741.48606.98.
- 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. doi: 10.1161/01.cir.0000437738.63853.7a.
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May 16;285(19):2486-97. PMID 11368702.
- Lloyd-Jones DM, Leip EP, Larson MG, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation. 2006 Feb 14;113(6):791-8. PMID 16461820.