Risk assessment for cardiovascular disease with nontraditional risk factors: US preventive services task force recommendation statement

Susan J. Curry, Alex H. Krist, Douglas K. Owens, Michael J. Barry, Aaron Caughey, Karina W. Davidson, Chyke A. Doubeni, John W. Epling, Alex R. Kemper, Martha Kubik, C. Seth Landefeld, Carol M. Mangione, Michael Silverstein, Melissa A. Simon, Chien Wen Tseng, John B. Wong

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

IMPORTANCE Cardiovascular disease (CVD) is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms. OBJECTIVE To update the 2009 US Preventive Services Task Force (USPSTF) recommendation on using nontraditional risk factors in coronary heart disease risk assessment. EVIDENCE REVIEW The USPSTF reviewed the evidence on using nontraditional risk factors in CVD risk assessment, focusing on the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score; the health benefits and harms of CVD risk assessment and treatment guided by nontraditional risk factors combined with the Framingham Risk Score or Pooled Cohort Equations compared with using either risk assessment model alone; and whether adding nontraditional risk factors to existing CVD risk assessment models improves measures of calibration, discrimination, and risk reclassification. FINDINGS The USPSTF found adequate evidence that adding the ABI, hsCRP level, and CAC score to existing CVD risk assessment models results in small improvements in discrimination and risk reclassification; however, the clinical meaning of these changes is largely unknown. Evidence on adding the ABI, hsCRP level, and CAC score to the Pooled Cohort Equations is limited. The USPSTF found inadequate evidence to assess whether treatment decisions guided by the ABI, hsCRP level, or CAC score, in addition to risk factors in existing CVD risk assessment models, leads to reduced incidence of CVD events or mortality. The USPSTF found adequate evidence to conceptually bound the harms of early detection and interventions as small. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, hsCRP level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent CVD events. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP level, or CAC score to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events.

Original languageEnglish (US)
Pages (from-to)272-280
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume320
Issue number3
DOIs
StatePublished - Jul 17 2018

Fingerprint

Advisory Committees
Cardiovascular Diseases
Ankle Brachial Index
C-Reactive Protein
Coronary Vessels
Calcium
Insurance Benefits
Calibration
Coronary Disease
Cause of Death

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Risk assessment for cardiovascular disease with nontraditional risk factors : US preventive services task force recommendation statement. / Curry, Susan J.; Krist, Alex H.; Owens, Douglas K.; Barry, Michael J.; Caughey, Aaron; Davidson, Karina W.; Doubeni, Chyke A.; Epling, John W.; Kemper, Alex R.; Kubik, Martha; Landefeld, C. Seth; Mangione, Carol M.; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien Wen; Wong, John B.

In: JAMA - Journal of the American Medical Association, Vol. 320, No. 3, 17.07.2018, p. 272-280.

Research output: Contribution to journalArticle

Curry, SJ, Krist, AH, Owens, DK, Barry, MJ, Caughey, A, Davidson, KW, Doubeni, CA, Epling, JW, Kemper, AR, Kubik, M, Landefeld, CS, Mangione, CM, Silverstein, M, Simon, MA, Tseng, CW & Wong, JB 2018, 'Risk assessment for cardiovascular disease with nontraditional risk factors: US preventive services task force recommendation statement', JAMA - Journal of the American Medical Association, vol. 320, no. 3, pp. 272-280. https://doi.org/10.1001/jama.2018.8359
Curry, Susan J. ; Krist, Alex H. ; Owens, Douglas K. ; Barry, Michael J. ; Caughey, Aaron ; Davidson, Karina W. ; Doubeni, Chyke A. ; Epling, John W. ; Kemper, Alex R. ; Kubik, Martha ; Landefeld, C. Seth ; Mangione, Carol M. ; Silverstein, Michael ; Simon, Melissa A. ; Tseng, Chien Wen ; Wong, John B. / Risk assessment for cardiovascular disease with nontraditional risk factors : US preventive services task force recommendation statement. In: JAMA - Journal of the American Medical Association. 2018 ; Vol. 320, No. 3. pp. 272-280.
@article{6a287b8793c94e9fb76fa8079710ab10,
title = "Risk assessment for cardiovascular disease with nontraditional risk factors: US preventive services task force recommendation statement",
abstract = "IMPORTANCE Cardiovascular disease (CVD) is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms. OBJECTIVE To update the 2009 US Preventive Services Task Force (USPSTF) recommendation on using nontraditional risk factors in coronary heart disease risk assessment. EVIDENCE REVIEW The USPSTF reviewed the evidence on using nontraditional risk factors in CVD risk assessment, focusing on the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score; the health benefits and harms of CVD risk assessment and treatment guided by nontraditional risk factors combined with the Framingham Risk Score or Pooled Cohort Equations compared with using either risk assessment model alone; and whether adding nontraditional risk factors to existing CVD risk assessment models improves measures of calibration, discrimination, and risk reclassification. FINDINGS The USPSTF found adequate evidence that adding the ABI, hsCRP level, and CAC score to existing CVD risk assessment models results in small improvements in discrimination and risk reclassification; however, the clinical meaning of these changes is largely unknown. Evidence on adding the ABI, hsCRP level, and CAC score to the Pooled Cohort Equations is limited. The USPSTF found inadequate evidence to assess whether treatment decisions guided by the ABI, hsCRP level, or CAC score, in addition to risk factors in existing CVD risk assessment models, leads to reduced incidence of CVD events or mortality. The USPSTF found adequate evidence to conceptually bound the harms of early detection and interventions as small. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, hsCRP level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent CVD events. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP level, or CAC score to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events.",
author = "Curry, {Susan J.} and Krist, {Alex H.} and Owens, {Douglas K.} and Barry, {Michael J.} and Aaron Caughey and Davidson, {Karina W.} and Doubeni, {Chyke A.} and Epling, {John W.} and Kemper, {Alex R.} and Martha Kubik and Landefeld, {C. Seth} and Mangione, {Carol M.} and Michael Silverstein and Simon, {Melissa A.} and Tseng, {Chien Wen} and Wong, {John B.}",
year = "2018",
month = "7",
day = "17",
doi = "10.1001/jama.2018.8359",
language = "English (US)",
volume = "320",
pages = "272--280",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Risk assessment for cardiovascular disease with nontraditional risk factors

T2 - US preventive services task force recommendation statement

AU - Curry, Susan J.

AU - Krist, Alex H.

AU - Owens, Douglas K.

AU - Barry, Michael J.

AU - Caughey, Aaron

AU - Davidson, Karina W.

AU - Doubeni, Chyke A.

AU - Epling, John W.

AU - Kemper, Alex R.

AU - Kubik, Martha

AU - Landefeld, C. Seth

AU - Mangione, Carol M.

AU - Silverstein, Michael

AU - Simon, Melissa A.

AU - Tseng, Chien Wen

AU - Wong, John B.

PY - 2018/7/17

Y1 - 2018/7/17

N2 - IMPORTANCE Cardiovascular disease (CVD) is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms. OBJECTIVE To update the 2009 US Preventive Services Task Force (USPSTF) recommendation on using nontraditional risk factors in coronary heart disease risk assessment. EVIDENCE REVIEW The USPSTF reviewed the evidence on using nontraditional risk factors in CVD risk assessment, focusing on the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score; the health benefits and harms of CVD risk assessment and treatment guided by nontraditional risk factors combined with the Framingham Risk Score or Pooled Cohort Equations compared with using either risk assessment model alone; and whether adding nontraditional risk factors to existing CVD risk assessment models improves measures of calibration, discrimination, and risk reclassification. FINDINGS The USPSTF found adequate evidence that adding the ABI, hsCRP level, and CAC score to existing CVD risk assessment models results in small improvements in discrimination and risk reclassification; however, the clinical meaning of these changes is largely unknown. Evidence on adding the ABI, hsCRP level, and CAC score to the Pooled Cohort Equations is limited. The USPSTF found inadequate evidence to assess whether treatment decisions guided by the ABI, hsCRP level, or CAC score, in addition to risk factors in existing CVD risk assessment models, leads to reduced incidence of CVD events or mortality. The USPSTF found adequate evidence to conceptually bound the harms of early detection and interventions as small. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, hsCRP level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent CVD events. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP level, or CAC score to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events.

AB - IMPORTANCE Cardiovascular disease (CVD) is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms. OBJECTIVE To update the 2009 US Preventive Services Task Force (USPSTF) recommendation on using nontraditional risk factors in coronary heart disease risk assessment. EVIDENCE REVIEW The USPSTF reviewed the evidence on using nontraditional risk factors in CVD risk assessment, focusing on the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score; the health benefits and harms of CVD risk assessment and treatment guided by nontraditional risk factors combined with the Framingham Risk Score or Pooled Cohort Equations compared with using either risk assessment model alone; and whether adding nontraditional risk factors to existing CVD risk assessment models improves measures of calibration, discrimination, and risk reclassification. FINDINGS The USPSTF found adequate evidence that adding the ABI, hsCRP level, and CAC score to existing CVD risk assessment models results in small improvements in discrimination and risk reclassification; however, the clinical meaning of these changes is largely unknown. Evidence on adding the ABI, hsCRP level, and CAC score to the Pooled Cohort Equations is limited. The USPSTF found inadequate evidence to assess whether treatment decisions guided by the ABI, hsCRP level, or CAC score, in addition to risk factors in existing CVD risk assessment models, leads to reduced incidence of CVD events or mortality. The USPSTF found adequate evidence to conceptually bound the harms of early detection and interventions as small. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, hsCRP level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent CVD events. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP level, or CAC score to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events.

UR - http://www.scopus.com/inward/record.url?scp=85050154034&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050154034&partnerID=8YFLogxK

U2 - 10.1001/jama.2018.8359

DO - 10.1001/jama.2018.8359

M3 - Article

C2 - 29998297

AN - SCOPUS:85050154034

VL - 320

SP - 272

EP - 280

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 3

ER -