ASCVD and Very High Risk of Future ASCVD Events

CARDIOLOGY

Past ASCVD events are risk factors for future events. The existence of high-risk conditions as well.

From the AHA/ACC 2018 cholesterol guidelines.

Clinical ASCVD

Clinical ASCVD consists of the following conditions of atherosclerotic origin.

  • ACS,
  • history of MI,
  • stable or unstable angina or coronary other arterial revascularization,
  • stroke,
  • transient ischemic attack (TIA), or
  • peripheral artery disease (PAD)
  • aortic aneurysm,

Very High-Risk* of Future ASCVD Events

“Very high-risk includes a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions.” AHA/ACC 2018

Major ASCVD Events

  • Recent ACS (within the past 12 mo)
  • History of MI (other than recent ACS event listed above)
  • History of ischemic stroke
  • Symptomatic peripheral arterial disease (history of claudication with ABI <0.85, or previous revascularization or amputation)

People w/ established ASCVD are at high risk for a CVD event.

High-Risk Conditions

Also, treat the following patients as seriously as patients w/ established ASCVD.

  • Age ≥65 y
  • Heterozygous familial hypercholesterolemia
  • History of prior coronary artery bypass surgery or percutaneous coronary intervention outside of the major ASCVD event(s)
  • Diabetes mellitus
  • Hypertension
  • CKD (eGFR 15-59 mL/min/1.73 m2 )
  • Current smoking
  • Persistently elevated LDL-C (LDL-C ≥100 mg/dL [≥2.6 mmol/L]) despite maximally tolerated statin therapy and ezetimibe History of congestive HF
  • Need for revascularization while on a statin.
  • Recurrent ASCVD event risk while on statin treatment.

See more ASCVD risk factors here.

* Per AHA/ACC 2018 Guidelines, “Very high risk includes a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions”

 

Source

AHA/ACC 2018 Cholesterol Guidelines. https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625

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