title: A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease.
abstract: BACKGROUND
  The 2013 American College of Cardiology/American Heart Association updated cholesterol guidelines recommend the use of Pooled Cohort Equations to estimate 10-year absolute risk for atherosclerotic cardiovascular disease (ASCVD) in primary prevention.
  
  
  OBJECTIVE
  This study sought to systematically examine the Pooled Cohort Equations to determine risk factor levels required to exceed risk thresholds outlined in new cholesterol guidelines.
  
  
  METHODS
  We entered continuous risk factor levels in isolation and in specified combinations with the risk tool, and we observed predicted risk output patterns. We used the 10-year ASCVD risk threshold of ≥7.5% as a clinically relevant risk threshold.
  
  
  RESULTS
  We demonstrated that a hypothetical man or woman can reach clinically relevant risk thresholds throughout the eligible age spectrum of 40 to 79 years of age, depending on the associated risk factor burden in all race-sex groups. Age continues to be a major determinant of 10-year ASCVD risk for both men and women. Compared with the previous risk assessment tool used in cholesterol guidelines, the inclusion of a stroke endpoint and use of race-specific coefficients permit identification of at-risk African Americans and non-Hispanic white women at much younger ages and lower risk factor levels.
  
  
  CONCLUSIONS
  These data provide context of specific risk factor levels and groups of individuals who are likely to have 10-year ASCVD risk estimates ≥7.5%. Age continues to be a major driver of risk, which highlights the importance of the clinician-patient discussion before statin therapy is initiated.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Kunal N
authors.initials: KN
authors.lastname: Karmali
authors.affiliation: Colorado School of Public Health, Aurora, Colorado.
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: dlj@northwestern.edu.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000572:American Heart Association; D050197:Atherosclerosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D015995:Prevalence; D011322:Primary Prevention / Q000592:standards; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: cardiovascular disease; primary prevention; risk assessment; risk factors