US Preventive Services Task Force., Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB, et al.
JAMA. Date of publication 2018 Jul 17;volume 320(3):272-280.
1. JAMA. 2018 Jul 17;320(3):272-280. doi: 10.1001/jama.2018.8359.
Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US
Preventive Services Task Force Recommendation Statement.
US Preventive Services Task Force, Curry SJ(1), Krist AH(2)(3), Owens DK(4)(5),
Barry MJ(6), Caughey AB(7), Davidson KW(8), Doubeni CA(9), Epling JW Jr(10),
Kemper AR(11), Kubik M(12), Landefeld CS(13), Mangione CM(14), Silverstein M(15),
Simon MA(16), Tseng CW(17)(18), Wong JB(19).
Author information:
(1)University of Iowa, Iowa City.
(2)Fairfax Family Practice Residency, Fairfax, Virginia.
(3)Virginia Commonwealth University, Richmond.
(4)Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
(5)Stanford University, Stanford, California.
(6)Harvard Medical School, Boston, Massachusetts.
(7)Oregon Health & Science University, Portland.
(8)Columbia University, New York, New York.
(9)University of Pennsylvania, Philadelphia.
(10)Virginia Tech Carilion School of Medicine, Roanoke.
(11)Nationwide Children's Hospital, Columbus, Ohio.
(12)Temple University, Philadelphia, Pennsylvania.
(13)University of Alabama at Birmingham.
(14)University of California, Los Angeles.
(15)Boston University, Boston, Massachusetts.
(16)Northwestern University, Evanston, Illinois.
(17)University of Hawaii, Honolulu.
(18)Pacific Health Research and Education Institute, Honolulu, Hawaii.
(19)Tufts University, Medford, Massachusetts.
Comment in
JAMA. 2018 Jul 17;320(3):242-244.
Summary for patients in
JAMA. 2018 Jul 17;320(3):316.
Importance: Cardiovascular disease (CVD) is the most common cause of death among
adults in the United States. Treatment to prevent CVD events by modifying risk
factors is currently informed by the Framingham Risk Score, the Pooled Cohort
Equations, or similar CVD risk assessment models. If current CVD risk assessment
models could be improved by adding more risk factors, treatment might be better
targeted, thereby maximizing the benefits and minimizing the harms.
Objective: To update the 2009 US Preventive Services Task Force (USPSTF)
recommendation on using nontraditional risk factors in coronary heart disease
risk assessment.
Evidence Review: The USPSTF reviewed the evidence on using nontraditional risk
factors in CVD risk assessment, focusing on the ankle-brachial index (ABI),
high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium
(CAC) score; the health benefits and harms of CVD risk assessment and treatment
guided by nontraditional risk factors combined with the Framingham Risk Score or
Pooled Cohort Equations compared with using either risk assessment model alone;
and whether adding nontraditional risk factors to existing CVD risk assessment
models improves measures of calibration, discrimination, and risk
reclassification.
Findings: The USPSTF found adequate evidence that adding the ABI, hsCRP level,
and CAC score to existing CVD risk assessment models results in small
improvements in discrimination and risk reclassification; however, the clinical
meaning of these changes is largely unknown. Evidence on adding the ABI, hsCRP
level, and CAC score to the Pooled Cohort Equations is limited. The USPSTF found
inadequate evidence to assess whether treatment decisions guided by the ABI,
hsCRP level, or CAC score, in addition to risk factors in existing CVD risk
assessment models, leads to reduced incidence of CVD events or mortality. The
USPSTF found adequate evidence to conceptually bound the harms of early detection
and interventions as small. The USPSTF concludes that the current evidence is
insufficient to assess the balance of benefits and harms of using the ABI, hsCRP
level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent
CVD events.
Conclusions and Recommendation: The USPSTF concludes that the current evidence is
insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP
level, or CAC score to traditional risk assessment for CVD in asymptomatic adults
to prevent CVD events. (I statement).
DOI: 10.1001/jama.2018.8359
PMID: 29998297 [Indexed for MEDLINE]
