The new “intermediate risk” group: A comparative analysis of the new 2013 ACC/AHA risk assessment guidelines versus prior guidelines in men
Section snippets
Background
Prior guidelines on risk assessment and therapy in the primary prevention of coronary heart disease (CHD) identified a large intermediate risk group (10–20% 10-year CHD risk) in whom treatment decisions were considered uncertain [1]. In this group, further testing was recommended to further personalize risk estimates [2]. The new 2013 ACC/AHA Report on the Assessment of Cardiovascular (CVD) Risk, which contains new Pooled Cohort Risk Equations, reinterpreted conventional risk categories [3].
Methods
We analyzed data from 30,005 adult men free of known CVD from a large, multi-ethnic electronic medical record (EMR)-based registry study of middle-aged adults underdoing cardiovascular testing at a single metropolitan hospital system in the United States (1991–2009). Baseline demographic and risk factor data were derived from an in-person questionnaire and were supplemented and verified using data from the EMR and pharmacy claims files. Resting blood pressure was measured in the seated position
Results
The mean age of our sample was 52.8 ± 13 years. Approximately 24% were African-American. Table 1 shows the baseline characteristics for the two intermediate risk groups. Patients identified as intermediate risk under the new ACC/AHA guidelines were younger, more likely to be African-American, with lower risk factor burden compared to the traditional intermediate risk group (all p < 0.05).
Table 2 and Fig. 1 compare the risk categories between the two guidelines. Approximately 16% of patients
Discussion
In summary, the new 2013 ACC/AHA risk assessment guidelines produce a smaller “intermediate risk” group with less severe risk factor abnormalities compared to the traditional intermediate risk group. Based on our time-to-high-risk analysis, patients appear to rapidly progress out of the intermediate risk group and into the high risk group based on advancing age alone. These findings have distinct implications for risk assessment and clinical decision making in primary prevention.
The
Conflict of interest
None declared.
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