The Use of Risk-Enhancing Factors to Personalize ASCVD Risk Assessment: Evidence and Recommendations from the 2018 AHA/ACC Multi-Society Cholesterol Guidelines
Purpose of Review
In 2018, the AHA/ACC Multi-Society Cholesterol Guidelines introduced the novel concept of risk-enhancing factors to be used as a supplement to the pooled cohort risk equations to personalize atherosclerotic cardiovascular disease risk assessment in primary prevention. In this review, we discuss the rationale and evidence behind each of the risk-enhancing factors to help clinicians perform a more personalized cardiovascular risk assessment.
The risk-enhancing factors are high-risk features that may guide the use of lipid-lowering therapy particularly in intermediate and select borderline-risk patients. For the purpose of this review, these factors are divided into five categories: (i) race and genetics, (ii) conditions specific to women, (iii) lipid-related risk, (iv) concurrent high-risk medical conditions, and (v) biomarkers.
The addition of the risk-enhancing factors to the pooled cohort equations provides a more individualized and comprehensive approach to cardiovascular disease risk assessment.
KeywordsRisk-enhancing factors Atherosclerotic cardiovascular disease Risk assessment Race and genetics Biomarkers Lipid
This study was supported by Abbott Diagnostic, Akcea, Amgen, Esperion, Novartis, Regeneron, Roche Diagnostic, Sanofi-Synthelabo, NIH, AHA, and ADA. All were paid to institution, not individual.
The following acted as consultants: Abbott Diagnostics, Akcea, Amarin, Amgen, Astra Zeneca*, Boehringer Ingelheim, Denka Seiken, Esperion, Intercept, Janssen, Matinas BioPharma Inc., Merck*, Novartis, Novo Nordisk, Regeneron, Roche Diagnostic, and Sanofi-Synthelabo* (*significant where noted (> $10,000); remainder modest (< $10,000)).
Compliance with Ethical Standards
Conflict of Interest
Anandita Agarwala MD, Jing Liu MD, and Salim S. Virani MD declare that they have no conflict of interest. Dr. Virani was supported by research funding from the Department of Veterans Affairs Health Services Research & Development Service Investigator Initiated Grant, World Heart Federation, and the Jooma and Tahir Family. Dr. Ballantyne was supported by R01-HL134320.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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