Ascvd risk estimator
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ASCVD Risk Estimator: Insights and Applications
Introduction to ASCVD Risk Estimator
The Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator is a tool designed to predict the 10-year risk of cardiovascular events such as heart attacks and strokes. Developed by the American College of Cardiology (ACC) and the American Heart Association (AHA), this tool is widely used in clinical practice to guide preventive measures and manage cardiovascular health.
Predictive Accuracy and Overestimation Concerns
Overestimation in Diverse Populations
Several studies have highlighted concerns regarding the overestimation of risk by the ASCVD Risk Estimator. Research using the Multi-Ethnic Study of Atherosclerosis (MESA) found that the ASCVD risk score overestimates risk across different ethnic groups, with the highest overestimation observed among Chinese participants. This overestimation was also noted in a modern, multiethnic cohort, where the ASCVD score overestimated cardiovascular events by 25% to 115%. Factors such as age, systolic blood pressure, and the use of preventive therapies like lipid-lowering medications were associated with this overestimation.
Validation in Specific Populations
The ASCVD Risk Estimator has been validated in various populations, including the Chinese population through the China-PAR project. This project developed and validated 10-year risk prediction equations specifically for the Chinese population, showing good performance and calibration. However, the ASCVD score's performance in HIV-infected patients in sub-Saharan Africa indicated potential misclassification, suggesting the need for tailored risk prediction equations for specific populations.
Utility in Clinical Practice
Resistant Hypertension Prediction
The ASCVD-10 risk score has shown potential in predicting true resistant hypertension (TRH) in high-risk overweight and obese hypertensive subjects. A study found that a higher ASCVD-10 score was associated with an increased likelihood of TRH, suggesting its utility in identifying patients at risk for this condition.
Peripheral Arterial Disease Outcomes
In patients with peripheral arterial disease (PAD) undergoing lower extremity revascularization (LER), high ASCVD risk scores were correlated with worse outcomes, including higher long-term mortality and inferior amputation-free survival. This indicates that the ASCVD Risk Estimator can be useful for risk stratification in PAD patients.
Incorporation of Nontraditional Risk Markers
The addition of nontraditional risk markers such as the coronary artery calcium (CAC) score, ankle-brachial index (ABI), and family history (FH) to the ASCVD risk estimator has been evaluated. Among these, the CAC score modestly improved the predictive accuracy of the ASCVD risk estimator, while ABI and FH did not significantly enhance its discriminative ability.
Conclusion
The ASCVD Risk Estimator is a valuable tool in predicting cardiovascular risk and guiding preventive strategies. However, its tendency to overestimate risk in diverse populations and specific patient groups highlights the need for careful interpretation and potential adjustments. Incorporating nontraditional risk markers and developing tailored risk prediction models for specific populations can enhance its accuracy and utility in clinical practice.
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