Ascvd score
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Understanding the ASCVD Score: Insights from Recent Research
Introduction to ASCVD Score
The Atherosclerotic Cardiovascular Disease (ASCVD) risk score is a widely used tool designed to estimate the 10-year risk of cardiovascular events such as heart attacks and strokes. Developed by the American Heart Association (AHA) and the American College of Cardiology (ACC), this score helps clinicians make informed decisions about preventive therapies for cardiovascular disease.
Calibration and Discrimination of ASCVD Score
Overestimation of Risk
Recent studies have highlighted significant overestimation of cardiovascular risk by the ASCVD score. In a multiethnic cohort study, the ASCVD score overestimated cardiovascular events by 37% to 154% in men and 8% to 67% in women. This overestimation was consistent across different risk levels and was not explained by preventive therapies such as aspirin or lipid-lowering medications. Another study confirmed these findings, showing that the ASCVD score overestimated risk among all race/ethnic groups, with the highest overestimation observed in Chinese men and women.
Comparison with Other Risk Scores
When compared to other risk scores, the ASCVD score often showed higher risk estimates. For instance, the ASCVD score classified more patients as high-risk compared to the Framingham Risk Score (FRS) in HIV-infected patients in sub-Saharan Africa. Similarly, in a study involving primary prevention patients, the ASCVD score overestimated the 10-year coronary heart disease risk compared to the MESA-CAC score, leading to significant reclassification of risk levels.
Predictive Ability in Specific Populations
Erectile Dysfunction and ASCVD Score
The ASCVD score has also been applied in specific patient populations, such as men with erectile dysfunction (ED). A study found that the ASCVD score was a strong predictor of arteriogenic ED, suggesting that it could be a valuable tool for identifying patients at higher cardiovascular risk in this subgroup.
Older Adults and Coronary Artery Calcium Score
In older adults, the coronary artery calcium (CAC) score has been shown to be a better predictor of incident coronary heart disease (CHD) than age alone. Adding the CAC score to traditional risk factors improved the discrimination of CHD risk, suggesting that CAC scoring could be a useful adjunct to the ASCVD score in older populations.
Implications for Clinical Practice
Tailoring Risk Assessment
The overestimation of risk by the ASCVD score has important implications for clinical practice. Clinicians should be cautious when interpreting ASCVD risk estimates, especially in populations where overestimation is more pronounced. The use of additional markers such as the CAC score can help refine risk assessment and guide decisions about preventive therapies.
Special Considerations for HIV-Infected Patients
For HIV-infected patients, the ASCVD score may not fully capture the elevated cardiovascular risk. There is a need for tailored risk prediction models that account for the unique risk factors in this population.
Conclusion
The ASCVD risk score is a valuable tool for estimating cardiovascular risk, but recent research indicates that it often overestimates risk, particularly in certain populations. Clinicians should consider using additional markers like the CAC score to improve risk prediction and tailor preventive strategies more effectively. Further research is needed to develop and validate risk prediction models that are more accurate for diverse populations, including those with specific health conditions like HIV.
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