Fast Five Quiz: Coronary Artery Atherosclerosis Management

Arnold S. Baas, MD


May 06, 2022

Figure 1. 3D computer illustration of visceral fat and atherosclerosis.

Assessing a patient's risk is the cornerstone of preventive cardiology and the first step for determining the suitability and intensity of preventive treatment for individual patients. The 2019 American College of Cardiology/American Heart Association Primary Prevention of Cardiovascular Disease Guideline recommends the Pooled Cohort Risk Estimator Plus (also known as the pooled cohort equations) for global risk scoring of a patient's 10-year risk for ASCVD. This information can then be used to initiate a conversation with patients about risk-reducing strategies and to guide decision-making for preventive interventions. Population-based risk scores must be interpreted in the context of individual patients' specific circumstances, however, to avoid overestimating or underestimating risk.

According to a 2019 study, age, sex, and race captured 63%-80% of the prognostic performance of cardiovascular risk models, while modifiable risk factors only contributed modestly. However, control of modifiable risk factors led to substantial reductions in cardiac events.

Numerous modifiable and nonmodifiable risk factors for ASCVD have been identified, including autoimmune disorders, such as rheumatoid arthritis and lupus. Other risk factors include:

  • Hyperlipidemia and dyslipidemia

  • Hypertension

  • Cigarette and tobacco use

  • Air pollution

  • Diabetes mellitus

  • Age

  • Sex

  • Family history

  • Obesity

  • Sedentary lifestyle

  • Sleep disorders, such as obstructive sleep apnea

  • Chronic kidney disease

Learn more about primary and secondary prevention of cardiovascular disease.


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