Preventive Cardiology and Risk Assessment: Beyond LDL
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CORONARY HEART DISEASE (S. VIRANI AND S. NADERI, SECTION EDITOR)
Preventive Cardiology and Risk Assessment: Beyond LDL Amit Goyal 1
&
Leslie Cho 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Risk assessment is the foundational cornerstone for cardiovascular prevention. The goal of this review is to apprise the reader of the latest evidence and guideline-based stepwise method for clinical risk assessment for future atherosclerotic events. We also discuss caveats to the current approach and review future directions including the promise of precision medicine. Recent Findings The most recent cholesterol and prevention guidelines improve upon the widely used pooled cohort equations by incorporating risk-enhancing factors to further personalize risk assessment. For those in whom uncertainty remains, there is mounting evidence for using the coronary calcium score to uncover subclinical disease to either up- or down-classify risk. Although still in its infancy, progress in high-throughput molecular analysis is edging the field closer to more precise risk stratification. Summary Atherosclerosis is the leading cause of global morbidity and mortality. Emphasis on cardiovascular prevention is essential to mitigate the burden of disease. Here, we introduce a “4 + 2” paradigm for approaching preventive cardiology based on recent guidelines. Risk stratification is performed in four steps: qualitative risk approximation to initiate counseling and education, quantitative risk estimation based on a validated model, personalization with risk-enhancing factors, and measurement of coronary artery calcium score in select patients. The two foundational principles of preventive management are to promote a healthy lifestyle in all and to escalate preventive pharmacotherapy based on increasing risk. Shared decision-making remains central throughout this process. Keywords Atherosclerosis . Cholesterol . Diabetes . Pooled cohort equations . Coronary artery calcium score . Lifestyle
Introduction Prevention of atherosclerotic cardiovascular disease relies on lifestyle and pharmacologic therapies. The intensity of lifestyle counseling and medical management are triaged based upon an individual patient’s estimated future risk of atherosclerotic cardiovascular disease (ASCVD). The greatest benefit is accrued in those with the greatest risk. Risk estimation therefore is a central pillar of preventive cardiology. Here we review the stepwise approach for ASCVD risk stratification based on the 2018 cholesterol and 2019 primary prevention guidelines as well as provide a critical update of recent literature [1••, 2••, 3]. This article is part of the Topical Collection on Coronary Heart Disease * Leslie Cho [email protected] 1
Cleveland Clinic Foundation, Heart Vascular Institute, 9500 Euclid Avenue JB-1, Cleveland, OH 44195, USA
Epidemiology of Atherosclerotic Cardiovascular Disease Atherosclerotic cardiovascular disease (ASCVD) broadly encompasses the variety of pathologies caused by atheroscleros
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