(Circulation. 1999;100:1481-1492.)
© 1999 American Heart Association, Inc.
AHA/ACC Scientific Statement |
Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations
A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology
Key Words: AHA/ACC Scientific Statement • coronary disease • risk factors • risk assessment
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Introduction |
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The past decade has witnessed major strides in the prevention of coronary heart disease (CHD) through modification of its causes. The most dramatic advance has been the demonstration that aggressive medical therapy will substantially reduce the likelihood of recurrent major coronary syndromes in patients with established CHD (secondary prevention). The American Heart Association (AHA) and the American College of Cardiology (ACC) have published joint recommendations for medical intervention in patients with CHD and other forms of atherosclerotic disease.1 A similar potential exists for risk reduction in patients without established CHD (primary prevention). However, the risk status of persons without CHD varies greatly, and this variability mandates a range in the intensity of interventions. Effective primary prevention thus requires an assessment of risk to categorize patients for selection of appropriate interventions. The present statement is being published jointly by the AHA and ACC to outline current issues and approaches to global risk assessment for primary prevention. The approaches described in this statement can be used for guidance at several levels of primary prevention; however, the statement does not attempt to specifically link risk assessment to treatment guidelines for particular risk factors. Nonetheless, it provides critical background information that can be used in the development of new treatment guidelines.
The major and independent risk factors for CHD are cigarette smoking of
any amount, elevated blood pressure, elevated serum total
cholesterol and low-density lipoprotein
cholesterol (LDL-C), low serum high-density lipoprotein
cholesterol (HDL-C), diabetes mellitus, and advancing age
(Table 1
). The quantitative
relationship
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H. Eyre, R. Kahn, and R. M. Robertson Preventing Cancer, Cardiovascular Disease, and Diabetes: A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association Diabetes Care, July 1, 2004; 27(7): 1812 - 1824. [Abstract] [Full Text] [PDF]
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H. Eyre, R. Kahn, R. M. Robertson, the ACS/ADA/AHA Collaborative Writing Committee, ACS/ADA/AHA Collaborative Writing Committee Member, N. G. Clark, C. Doyle, Y. Hong, T. Gansler, T. Glynn, et al. Preventing Cancer, Cardiovascular Disease, and Diabetes: A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association Circulation, June 29, 2004; 109(25): 3244 - 3255. [Abstract] [Full Text] [PDF]
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J. N. Cohn, A. A. Quyyumi, N. K. Hollenberg, and K. A. Jamerson Surrogate Markers for Cardiovascular Disease: Functional Markers Circulation, June 29, 2004; 109(25_suppl_1): IV-31 - IV-46. [Full Text] [PDF]
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P. M Ridker, P. W.F. Wilson, and S. M. Grundy Should C-Reactive Protein Be Added to Metabolic Syndrome and to Assessment of Global Cardiovascular Risk? Circulation, June 15, 2004; 109(23): 2818 - 2825. [Abstract] [Full Text] [PDF]
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S. Ebrahim, D. Montaner, and D. A Lawlor Clustering of risk factors and social class in childhood and adulthood in British women's heart and health study: cross sectional analysis BMJ, April 10, 2004; 328(7444): 861. [Abstract] [Full Text] [PDF]
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E. Schwedhelm, A. Bartling, H. Lenzen, D. Tsikas, R. Maas, J. Brummer, F.-M. Gutzki, J. Berger, J. C. Frolich, and R. H. Boger Urinary 8-iso-Prostaglandin F2{alpha} as a Risk Marker in Patients With Coronary Heart Disease: A Matched Case-Control Study Circulation, February 24, 2004; 109(7): 843 - 848. [Abstract] [Full Text] [PDF]
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P. Brindle, J. Emberson, F. Lampe, M. Walker, P. Whincup, T. Fahey, and S. Ebrahim Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study BMJ, November 29, 2003; 327(7426): 1267. [Abstract] [Full Text] [PDF]
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K. A Dornbrook-Lavender, J. A Pieper, and M. T Roth Primary Prevention of Coronary Heart Disease in the Elderly Ann. Pharmacother., November 1, 2003; 37(11): 1654 - 1663. [Abstract] [Full Text] [PDF]
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J. Genest, J. Frohlich, G. Fodor, and R. McPherson Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: summary of the 2003 update Can. Med. Assoc. J., October 28, 2003; 169(9): 921 - 924. [Full Text] [PDF]
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Committee Members, F. J. Klocke, M. G. Baird, B. H. Lorell, T. M. Bateman, J. V. Messer, D. S. Berman, P. T. O'Gara, B. A. Carabello, R. O. Russell Jr, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1318 - 1333. [Full Text] [PDF]
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F. J. Klocke, M. G. Baird, B. H. Lorell, T. M. Bateman, J. V. Messer, D. S. Berman, P. T. O'Gara, B. A. Carabello, R. O. Russell Jr, M. D. Cerqueira, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) Circulation, September 16, 2003; 108(11): 1404 - 1418. [Full Text] [PDF]
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R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Circulation, September 9, 2003; 108(10): 1278 - 1290. [Full Text] [PDF]
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E. S. Ganotakis, K. Mandalaki, M. Tampakaki, N. Malliaraki, E. Mandalakis, G. Vrentzos, J. Melissas, and E. Castanas Subclinical Hypothyroidism and Lipid Abnormalities in Older Women Attending a Vascular Disease Prevention Clinic: Effect of Thyroid Replacement Therapy Angiology, September 1, 2003; 54(5): 569 - 576. [Abstract] [PDF]
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R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Stroke, September 1, 2003; 34(9): 2310 - 2322. [Full Text] [PDF]
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P. Greenland, M. D. Knoll, J. Stamler, J. D. Neaton, A. R. Dyer, D. B. Garside, and P. W. Wilson Major Risk Factors as Antecedents of Fatal and Nonfatal Coronary Heart Disease Events JAMA, August 20, 2003; 290(7): 891 - 897. [Abstract] [Full Text] [PDF]
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R. C. Pasternak, J. Abrams, P. Greenland, L. A. Smaha, P. W. F. Wilson, and N. Houston-Miller Task force #1--identification of coronary heart disease risk: is there a detection gap? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1863 - 1874. [Full Text] [PDF]
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D. B. Mark, L. J. Shaw, M. S. Lauer, P. G. O'Malley, and P. Heidenreich Task force #5--is atherosclerosis imaging cost effective? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1906 - 1917. [Full Text] [PDF]
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R.M. Conroy, K. Pyorala, A.P. Fitzgerald, S. Sans, A. Menotti, G. De Backer, D. De Bacquer, P. Ducimetiere, P. Jousilahti, U. Keil, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project Eur. Heart J., June 1, 2003; 24(11): 987 - 1003. [Abstract] [Full Text] [PDF]
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H.-W. Hense, H. Schulte, H. Lowel, G. Assmann, and U. Keil Framingham risk function overestimates risk of coronary heart disease in men and women from Germany--results from the MONICA Augsburg and the PROCAM cohorts Eur. Heart J., May 2, 2003; 24(10): 937 - 945. [Abstract] [Full Text] [PDF]
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J. G. Douglas, G. L. Bakris, M. Epstein, K. C. Ferdinand, C. Ferrario, J. M. Flack, K. A. Jamerson, W. E. Jones, J. Haywood, R. Maxey, et al. Management of High Blood Pressure in African Americans: Consensus Statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks Arch Intern Med, March 10, 2003; 163(5): 525 - 541. [Full Text] [PDF]
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P. Di Napoli, A.A. Taccardi, M. Oliver, and R. De Caterina Statins and stroke: evidence for cholesterol-independent effects Eur. Heart J., December 2, 2002; 23(24): 1908 - 1921. [PDF]
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N. R.C. Campbell, D. Drouin, and R. D. Feldman The 2001 Canadian hypertension recommendations: take-home messages Can. Med. Assoc. J., September 1, 2002; 167(6): 661 - 668. [Full Text] [PDF]
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L. Swan and M.A. Gatzoulis Early atherosclerosis ...what does it mean? Eur. Heart J., September 1, 2002; 23(17): 1317 - 1319. [Full Text] [PDF]
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E. J. Benjamin, S. C. Smith Jr, R. S. Cooper, M. N. Hill, and R. V. Luepker Task Force #1--magnitude of the prevention problem: opportunities and challenges J. Am. Coll. Cardiol., August 21, 2002; 40(4): 588 - 603. [Full Text] [PDF]
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