2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

Goff, David C.; Lloyd‐Jones, Donald M.; Bennett, Gordon F.; Coady, Sean; D’Agostino, Ralph B.; Gibbons, Raymond J.; Greenland, Philip; Lackland, Daniel T.; Levy, Daniel; O’Donnell, Christopher J.; Robinson, Jennifer G.; Schwartz, J. Sanford; Shero, Susan T.; Smith, Sidney C.; Sorlie, Paul D.; Stone, Neil J.; Wilson, Peter W.F.

doi:10.1016/j.jacc.2013.11.005

Cited by 3,450 publications

(1,362 citation statements)

References 71 publications

(78 reference statements)

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“…2 (center) compares the lifespan‐predictive ability of the well‐known Framingham Risk Score (Wilson et al ., 1998; Lloyd‐Jones et al ., 2004) and Pooled Cohort Score (Goff et al ., 2014) with our ‘focal exam’ estimates. These clinical scores were designed specifically to assess cardiovascular risk in a 5‐ to 10‐year timeframe, using some of the parameters we examined as well as smoking status, blood cholesterol, and age.…”

Section: Resultsmentioning

confidence: 77%

Predicting all‐cause mortality from basic physiology in the Framingham Heart Study

Zhang

Pincus

2015

Aging Cell

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SummaryUsing longitudinal data from a cohort of 1349 participants in the Framingham Heart Study, we show that as early as 28–38 years of age, almost 10% of variation in future lifespan can be predicted from simple clinical parameters. Specifically, we found diastolic and systolic blood pressure, blood glucose, weight, and body mass index (BMI) to be relevant to lifespan. These and similar parameters have been well‐characterized as risk factors in the relatively narrow context of cardiovascular disease and mortality in middle to old age. In contrast, we demonstrate here that such measures can be used to predict all‐cause mortality from mid‐adulthood onward. Further, we find that different clinical measurements are predictive of lifespan in different age regimes. Specifically, blood pressure and BMI are predictive of all‐cause mortality from ages 35 to 60, while blood glucose is predictive from ages 57 to 73. Moreover, we find that several of these parameters are best considered as measures of a rate of ‘damage accrual’, such that total historical exposure, rather than current measurement values, is the most relevant risk factor (as with pack‐years of cigarette smoking). In short, we show that simple physiological measurements have broader lifespan‐predictive value than indicated by previous work and that incorporating information from multiple time points can significantly increase that predictive capacity. In general, our results apply equally to both men and women, although some differences exist.

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Section: Resultsmentioning

confidence: 77%

Predicting all‐cause mortality from basic physiology in the Framingham Heart Study

Zhang

Pincus

2015

Aging Cell

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“…Therefore, the measurement of IMT alone may not be sufficiently accurate to predict the risk of CVDs. The American College of Cardiology/American Heart Association cardiovascular risk assessment guidelines in 2014 did not recommend sole IMT measurements 32. A combination of IMT and plaque assessment may provide more accurate information for clinical decision making, and further studies are required to evaluate the combined measurement of IMT and plaque for predicting long‐term cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Carotid Atherosclerosis Detected by Ultrasonography: A National Cross‐Sectional Study

Wang¹,

Li²,

Song

et al. 2018

JAHA

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BackgroundCarotid atherosclerosis (CA) is a reflector of generalized atherosclerosis that is associated with systemic vascular disease. Data are limited on the epidemiology of carotid lesions in a large, nationally representative population sample. We aimed to evaluate the prevalence of CA detected by carotid ultrasonography and related risk factors based on a national survey in China.Methods and ResultsA total of 107 095 residents aged ≥40 years from the China National Stroke Prevention Project underwent carotid ultrasound examination. Participants with carotid endarterectomy or carotid stenting and those with stroke or coronary heart disease were excluded. Data from 84 880 participants were included in the analysis. CA was defined as increased intima–media thickness (IMT) ≥1 mm or presence of plaques. Of the 84 880 participants, 46.4% were men, and the mean age was 60.7±10.3 years. The standardized prevalence of CA was 36.2% overall, increased with age, and was higher in men than in women. Prevalence of CA was higher among participants living in rural areas than in urban areas. Approximately 26.5% of participants had increased IMT, and 13.9% presented plaques. There was an age‐related increase in participants with increased IMT, plaque presence, and stenosis. In multiple logistic regression analysis, older age, male sex, residence in rural areas, smoking, alcohol consumption, physical inactivity, obesity, hypertension, diabetes mellitus, and dyslipidemia were associated with CA.Conclusions CA was highly prevalent in a middle‐aged and older Chinese population. This result shows the potential clinical importance of focusing on primary prevention of atherosclerosis progression.

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“…For the purpose of this study, major CHD events included recognized myocardial infarction and death from CHD, and major CVD events included major CHD events and ischemic stroke, in accordance with atherosclerotic CVD end points defined in the 2013 American College of Cardiology/American Heart Association risk assessment guidelines 22. In addition, we determined all‐cause mortality.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

Hoffmann

Massaro

D’Agostino

et al. 2016

JAHA

167

146

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BackgroundWe determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all‐cause mortality independent of Framingham risk factors in the community‐based Framingham Heart Study.Methods and ResultsCoronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C‐statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all‐cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all‐cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78–0.82; net reclassification index 32%, 95% CI 11–53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5–10%) 10‐year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%).Conclusions CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community‐dwelling persons and accurately reclassifies two‐thirds of the intermediate‐risk population.

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2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

Cited by 3,450 publications

References 71 publications

Predicting all‐cause mortality from basic physiology in the Framingham Heart Study

Predicting all‐cause mortality from basic physiology in the Framingham Heart Study

Carotid Atherosclerosis Detected by Ultrasonography: A National Cross‐Sectional Study

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

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