Walter Reed Researchers Seek to Improve Accuracy in CVD Risk Scoring

By Annette M. Boyle

Lauren Weber, MD, a cardiology fellow at WRNMMC

Lauren Weber, MD, a cardiology fellow at WRNMMC

BETHESDA, MD—Primary care physicians and cardiologists increasingly rely on risk factor-based scores to determine who should start preventive therapy for atherosclerotic cardiovascular disease (ASCVD). A growing body of evidence shows that reliance may lead to large-scale overtreatment—and may miss some individuals at significant risk.

A recent review led by researchers at Walter Reed National Military Medical Center in Bethesda, MD, compared current risk factor-based scores to coronary artery calcium scoring and carotid ultrasound to determine their relative strengths and weaknesses. The review, directed by senior author Army Lt. Col. Todd C. Villines, MD, appeared in Current Cardiovascular Imaging Reports.1

While traditional risk scores are simple, inexpensive and easy to use in an office setting, they have significant limitations. The pooled cohort-based calculator included in the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Risk Assessment and Cholesterol Treatment Guidelines, for instance, has generated controversy since its release for its systematic overestimation of risk. Testing of its clinical accuracy in three cohorts separate from the four National Heart, Lung, and Blood Institute studies used in its development showed a 75% to 150% overestimation of risk.2

Overestimation “may result in treating patients who don’t need pharmacologic therapy,” said Lauren Weber, MD, a cardiology fellow at WRNMMC. “Also, they don’t include some important risk factors, like family history of heart disease or duration or extent of risk factors which may impact a patient’s overall risk.”

The Canadian Heart Association guidelines double the estimated risk for individuals who have a first-degree relative with a history of cardiovascular disease before age 60. The ACC/AHA risk calculator also does not include prior statin therapy or how long an individual smoked. The study authors noted that it also had not been prospectively validated for its ability to improve ASCVD outcomes or among many ethnicities.


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