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ASCVD Risk Panel with Score

Test code(s) 92052, 92053

Question 1. Which guidelines support the use of 10-year and lifetime ASCVD risk estimates?

Two guidelines recommend use of atherosclerotic cardiovascular disease (ASCVD) risk estimates. The first is the American College of Cardiology (ACC) and the American Heart Association (AHA) guideline on assessment of cardiovascular risk.1 It recommends use of the new race-and sex-specific pooled cohort equations to estimate 10-year risk of a first ASCVD event. First ASCVD event was defined as a nonfatal myocardial infarction, coronary heart disease death, or stroke (fatal or nonfatal). This guideline also supports assessing lifetime ASCVD risk.

The second guideline is the ACC/AHA joint guideline on treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.2 It gives statin therapy recommendations based on the 10-year and lifetime ASCVD risk estimates.

Question 2. Which patients should have their 10-year and lifetime ASCVD risk assessed?

The guideline also states that estimation of ASCVD risk in patients from populations other than African Americans and nonHispanic whites may be considered.1 The sex-specific pooled cohort equations for nonHispanic whites should be used for this purpose. However, risk may be overestimated in Hispanic and Asian Americans.

The guideline recommends lifetime ASCVD risk assessment for 20- to 59-year-old patients who are without clinical cardiovascular disease and not at high 10-year risk.1

Question 3. Can I calculate 10-year and lifetime ASCVD risk estimates myself?

Yes. A spreadsheet enabling estimation of 10-year and lifetime risk for ASCVD is available for download at http://my.americanheart.org/cvriskcalculator.

The information required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status.

Question 4. No ASCVD risk was reported for my patient. Why?

Neither 10-year nor lifetime risks or risk goals will be calculated when:

  • There is missing patient information. The following are required for 10-year ASCVD risk estimates: age, sex, race, systolic blood pressure, blood pressure-lowering medication use, diabetes status, and smoking status. All but race are required for lifetime ASCVD risk estimates.
  • A patient’s information is not in the range accepted for risk calculation. Accepted ranges are:

–      Total cholesterol: 130-320 mg/dL

–      HDL-cholesterol: 20-100 mg/dL (not required for lifetime ASCVD risk estimates)

–      Systolic blood pressure: 90-200mm/Hg

–      Age: 40-79 for 10-year ASCVD risk and 20-59 for lifetime ASCVD risk

Question 5. How does the 10-year ASCVD risk estimate differ from the Framingham Study 10-year CHD risk estimate?

The 10-year ASCVD risk estimate assesses risk of nonfatal and fatal stroke in addition to assessing risk of CHD. The ASCVD risk estimate is based on data from multiple community-based cohorts and takes into account differences in risk between nonHispanic whites and African Americans.1 In contrast, the Framingham 10-year CHD risk estimate does not assess risk of stroke, is based on data from a single population-based study, and does not take into account differences in risk between nonHispanic whites and African Americans.3

 

References
 
  1. Goff DC, Jr., Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November 12, 2013]. Circulation. doi: 10.1161/01.cir.0000437741.48606.98.
  2. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November 12, 2013]. Circulation. doi:10.1161/01.cir.0000437738.63853.7a.
  3. 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;285:2486-2497.
This FAQ is provided for informational purposes only and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.

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