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Cardiovascular Risk Assessment (10-year, ACC/AHA PCE: Pooled Cohort Equations) and Optimization

 

Input
 

Race	American Indian or Alaska Native
	Asian
	Black or African American
	Native Hawaiian or Other Pacific Islander
	White
Sex	Female
	Male
Age		mo yr
Total Cholesterol		mg/dL mmol/L
HDL Cholesterol		mg/dL mmol/L
Systolic Blood Pressure		Pascal cmH2O mmHg mm[Hg] torr
On Hypertension Med	No
	Yes
Diabetes	No
	Yes
Smoker	No
	Yes

 
Results
 
Important: Inputs must be complete to perform calculation.

 

ACC AHA 10 Yr Risk		% fraction percent rate ratio
Decimal Precision   0 1 2 3

 

Data action

 
    Difficulty:   Easy Difficulty:   Medium Difficulty:   Hard

 

 

 

Notes

• This calculator helps predict the 10-year risk of the following hard ASCVD events:
  • First occurrence of nonfatal myocardial infarction
  • CHD death
  • Fatal or nonfatal stroke
• This calculator may overestimate risk (see Lancet reference) and a discussion with the patient needs to ensue if there are any questions.
• Risk estimates were developed from cohorts primarily comprising White and African American subjects. Risk may be underestimated in American Indians, Asian Americans of South Asian ancestry, and Puerto Ricans. Risk may be overestimated in Asian Americans of East Asian ancestry and some Mexican Americans.
• Optimization limits include: Total Cholesterol ≥100 mg/dL with a Total Cholesterol to HDL Cholesterol ratio ≥2. Systolic Blood Pressure must be ≥95 mmHg.
• Easy optimizations include:
   
  1) Decrease total cholesterol 10%  
  2) Increase HDL cholesterol 10%  
  3) Decrease systolic blood pressure 10%
• Medium intensity optimizations include:
   
  1) Decrease total cholesterol 20%  
  2) Increase HDL cholesterol 20%  
  3) Decrease systolic blood pressure 20%  
  4) Discontinue blood pressure medication  
  5) Quit smoking
• Hard optimizations include:
   
  1) Decrease total cholesterol 30%  
  2) Increase HDL cholesterol 30%  
  3) Decrease systolic blood pressure 30%

 
Equations used
 

Terms = (CAge * ln(Age)) + (CSqAge * ln(Age)2) + (CTotalChol * ln(TotalCholesterol)) + (CAgeTotalChol * ln(Age) * ln(TotalCholesterol)) + (CHDLChol * ln(HDLCholesterol)) + (CAgeHDLChol * ln(Age) * ln(HDLCholesterol)) + (OnHypertensionMed * COnHypertensionMeds * ln(SystolicBloodPressure)) + (OnHypertensionMed * CAgeOnHypertensionMeds * ln(Age) * ln(SystolicBloodPressure)) + (!OnHypertensionMed * COffHypertensionMeds * ln(SystolicBloodPressure)) + (!OnHypertensionMed * CAgeOffHypertensionMeds * ln(Age) * ln(SystolicBloodPressure)) + (CSmoker * Smoker) + (CAgeSmoker * ln(Age) * Smoker) + (CDiabetes * Diabetes)

ACCAHA10YrRisk = 100 * (1 - S10e(Terms-MeanTerms))

 

 

Calculation Details and Variables

• For Black or African American female patients CAge = 17.114; CSqAge = 0; CTotalChol = 0.94; CAgeTotalChol = 0; CHDLChol = -18.92; CAgeHDLChol = 4.475; COnHypertensionMeds = 29.291; CAgeOnHypertensionMeds = -6.432; COffHypertensionMeds = 27.82; CAgeOffHypertensionMeds = -6.087; CSmoker = 0.691; CAgeSmoker = 0; CDiabetes = 0.874; S10 = 0.9533; MeanTerms = 86.61.
• For White or other race female patients CAge = -29.799; CSqAge = 4.884; CTotalChol = 13.54; CAgeTotalChol = -3.114; CHDLChol = -13.578; CAgeHDLChol = 3.149; COnHypertensionMeds = 2.019; CAgeOnHypertensionMeds = 0; COffHypertensionMeds = 1.957; CAgeOffHypertensionMeds = 0; CSmoker = 7.574; CAgeSmoker = -1.665; CDiabetes = 0.661; S10 = 0.9665; MeanTerms = -29.18.
• For Black or African American male patients CAge = 2.469; CSqAge = 0; CTotalChol = 0.302; CAgeTotalChol = 0; CHDLChol = -0.307; CAgeHDLChol = 0; COnHypertensionMeds = 1.916; CAgeOnHypertensionMeds = 0; COffHypertensionMeds = 1.809; CAgeOffHypertensionMeds = 0; CSmoker = 0.549; CAgeSmoker = 0; CDiabetes = 0.645; S10 = 0.8954; MeanTerms = 19.54.
• For White or other race male patients CAge = 12.344; CSqAge = 0; CTotalChol = 11.853; CAgeTotalChol = -2.664; CHDLChol = -7.99; CAgeHDLChol = 1.769; COnHypertensionMeds = 1.797; CAgeOnHypertensionMeds = 0; COffHypertensionMeds = 1.764; CAgeOffHypertensionMeds = 0; CSmoker = 7.837; CAgeSmoker = -1.795; CDiabetes = 0.658; S10 = 0.9144; MeanTerms = 61.18.

 

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. Circulation. 2013 Nov 12. PubMed ID: 24222018
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. Circulation. 2013 Nov 12. PubMed ID: 24222016
3. Ridker PM, Cook NR. Statins: new American guidelines for prevention of cardiovascular disease. Lancet. 2013 Nov 30;382(9907):1762-5. doi: 10.1016/S0140-6736(13)62388-0. Epub 2013 Nov 20. PubMed ID: 24268611
4. Downs J, Good C. New Cholesterol Guidelines: Has Godot Finally Arrived? Ann Intern Med. 2014 Jan 28. doi: 10.7326/M13-2850. PubMed ID: 24473934
5. Vaishnava P, Eagle KA. ACP Journal Club. ACC/AHA, Adult Treatment Panel III, and ESC guidelines overestimated risk for CVD in older adults. Ann Intern Med. 2014 Aug 19;161(4):JC13. PubMed ID: 25133380
6. Kavousi M, Leening MJ, Nanchen D, et al. Comparison of Application of the ACC/AHA Guidelines, Adult Treatment Panel III Guidelines, and European Society of Cardiology Guidelines for Cardiovascular Disease Prevention in a European Cohort. JAMA. 2014 Mar 29. doi: 10.1001/jama.2014.2632. PubMed ID: 24681960
7. Navar-Boggan AM, Newby LK. ACC/AHA Pooled Cohort Risk Equations predicted 5-y risk for CV events in adults considered for statin initiation. Ann Intern Med. 2014 Aug 19;161(4):JC12. PubMed ID: 25133379
8. Muntner P, Colantonio LD, Cushman M, et al. Validation of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations. JAMA. 2014 Mar 29. doi: 10.1001/jama.2014.2630. PubMed ID: 24682252
9. DeFilippis AP, Young R, Carrubba CJ, et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015 Feb 17;162(4):266-75. PubMed ID: 25686167
10. Ridker PM, Cook NR. Comparing cardiovascular risk prediction scores. Ann Intern Med. 2015 Feb 17;162(4):313-4. PubMed ID: 25686171
11. Pursnani A, Massaro JM, D'Agostino RB Sr, et al. Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events. JAMA. 2015 Jul 14;314(2):134-41. PubMed ID: 26172893
12. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016 Nov 15;316(19):1997-2007. PubMed ID: 27838723
13. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646. PubMed ID: 30879355
14. Vasan RS, van den Heuvel E. Differences in estimates for 10-year risk of cardiovascular disease in Black versus White individuals with identical risk factor profiles using pooled cohort equations: an in silico cohort study. Lancet Digit Health. 2022 Jan;4(1):e55-e63. PubMed ID: 34952676

 

Associated Medical Subject Headings [MeSH]
 

80 and over, Adult, Advisory Committees, Age Factors, Aged, American Heart Association, Anticholesteremic Agents, Antihypertensive Agents, Aspirin, Atherosclerosis, Black or African American, Calcinosis, Calibration, Cardiology, Cardiovascular Diseases, Cholesterol, Clinical Decision-Making, Cohort Studies, Continental Population Groups, Coronary Artery Disease, Diabetes Complications, Dyslipidemias, Female, Follow-Up Studies, Heart Disease Risk Factors, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Hyperlipidemias, Hypolipidemic Agents, Incidence, Interviews as Topic, Kaplan-Meier Estimate, LDL, Longitudinal Studies, Male, Mass Screening, Mathematical Concepts, Medical, Middle Aged, Models, Myocardial Revascularization, Patient-Centered Care, Platelet Aggregation Inhibitors, Practice Guidelines as Topic, Primary Prevention, Prospective Studies, Research Report, Risk, Risk Assessment, Risk Factors, Secondary Prevention, Sex Factors, Societies, Stroke, Theoretical, Time Factors, United States, Voluntary Health Agencies, White People, World Health

 

Associated Logical Observation Identifiers Names and Codes [LOINC]
 

Parameter	LOINC's and Suggested Units
Age	21612-7 : yr      21612-7 : yr      21612-7 : years      30525-0 : Years old      30525-0 : yr      30525-0 : years
Total Cholesterol	2093-3 : mg/dL      14647-2 : mmol/L
HDL Cholesterol	2085-9 : mg/dL      14646-4 : mmol/L
Systolic Blood Pressure	8480-6 : mmHg
ACC AHA 10 Yr Risk	79423-0 : %

 
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