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cardiac risk assessment

Assessment of risk for cardiac & cardiovascular disease. Classification: - low risk < 5% - intermediate risk defined as 5%-7.5% - 7.5% - 10% high risk AAC/AHA, but not VAMC, USPSTF - > 10% high risk May include: 1) lipid panel 2) homocysteine in serum 3) electrocardiogram 4) cardiac stress testing 5) echocardiogram 6) computed tomography - coronary artery calcium score better than polygenic risk score [7] 7) coronary angiography Combination of: 1) cardiac-specific troponin-I 2) serum N-terminal pro-BNP 3) serum cystatin C (indicator of renal failure) 4) high-sensitivity serum C-reactive protein may predict risk of cardiovascular death in elderly men [2] high-sensitivity serum C-reactive protein indicated for patients at intermediate risk [4,5] Combination of serum apolipoprotein B, serum apolipoprotein A-1, serum lipoprotein & serum lipoprotein-associated phospholipase A2 less useful than total cholesterol + HDL cholesterol at predicting cardiovascular risk; adding these markers to conventional risk factors improved risk prediction only slightly [3] * measurements of nonfasting total & HDL cholesterol adequate [6] Also see perioperative risk assessment

Related

cardiac risk index (CRI) cardiovascular risk factor Framingham Risk Score/Calculator perioperative risk assessment

Specific

polygenic risk score

General

risk assessment screening

References

  1. Cardiac Risk Assessment Lab Tests Online: cardiac_risk
  2. Zethelius B et al, Use of multiple biomarkers to improve the prediction of death from cardiovascular causes. New Engl J Med 2008, 358:2107 PMID: 18480203 - deLemos JA and Lloyd-Jones DM Multiple biomarker panesl for cardiovascular risk assessment. New Engl J Med 2008, 358:2172 PMID: 18480211
  3. The Emerging Risk Factors Collaboration. Lipid-related markers and cardiovascular disease prediction. JAMA 2012 Jun 20; 307:2499. PMID: 2279745
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. Ridker PM, Danielson E, Fonseca FA Rosuvastatin to prevent vascular events in men and women with levated C-reactive protein. N Engl J Med. 2008 Nov 20;359(21):2195-207 PMID: 18997196
  6. Welsh C, Celis-Morales CA, Brown R et al. Comparison of conventional lipoprotein tests and apolipoproteins in the prediction of cardiovascular disease: Data from UK Biobank. Circulation 2019 Jun 20; PMID: 31216866 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.041149
  7. Khan SS et al. Coronary artery calcium score and polygenic risk score for the prediction of coronary heart disease events. JAMA 2023 May 23; 329:1768. PMID: 37219552 PMCID: PMC10208141 (available on 2023-11-23) https://jamanetwork.com/journals/jama/fullarticle/2805138