12 Use PREVENT Equations to Guide Diagnostic Testing and Pharmacotherapy While working in tandem with patients aged 30 to 79 to arrive at an informed treatment decision for primary prevention of cardiovascular disease, consider these important recommendations: PREVENT-CVD, PREVENT-ASCVD and PREVENT-HF Use the “CPR” Model: Step 1 Calculate patient baseline 10-year risk for PREVENT-CVD, PREVENT-ASCVD, and PREVENT-HF. Step 2 Personalize the estimated risk by considering 30-year ASCVD risk and ASCVD risk enhancers for patients at low risk (<3%) and borderline risk (3 to <5%) with PREVENT-ASCVD. For patients at lower risk (<7.5%) and increased risk (7.5 to <20%) with PREVENT-CVD, consider their 30-year CVD risk and CKM risk enhancers. Step 3 Possibly Reclassify a patient’s risk estimate with selective use of cardiac biomarker testing followed by transthoracic echocardiogram (TTE) if indicated, or CAC scoring, and Reassess treatment recommendations as needed.2,9 PREVENT-CVD • Use the PREVENT equations to inform CKM syndrome staging. Begin by evaluating CKM risk factors, then calculate CVD risk with the PREVENT-CVD equations. A 10-year PREVENT-CVD estimated ≥20% is defined as a risk equivalent to CKM syndrome Stage 3. Intensify CKM therapies as indicated.11 • For patients with lower (<7.5%) risk, consider 30-year PREVENT-CVD risk and CKM risk enhancers. • When 10-year predicted CVD risk using PREVENT-CVD is increased (7.5% to <20%), cardioprotective therapy, such as sodium-glucose cotransporter-2 inhibitors (SGLT2i) and/or glucagon-like peptide-1 (GLP-1)-based therapies should be initiated for patients with CKM syndrome Stage 2-3 with type 2 diabetes.11,2 • For patients with increased (≥7.5%) PREVENT-CVD risk, initiating intensive blood pressure-lowering drug therapy is recommended for BP ≥130/80 mm Hg.11,2 The PREVENT equations use a 7.5% 10-year total CVD risk threshold to guide treatment decisions for antihypertensive therapy, which is lower than the PCE (10-year ASCVD risk ≥10%).2 • For patients with high (≥20%) PREVENT-CVD risk, intensify CKM therapies as indicated.11 • Apolipoprotein B (ApoB) testing is reasonable to improve risk assessment and guide therapy once LDL-C and nonHDL-C goals are met, particularly in those with elevated triglycerides (TG) (>150 mg/dL), diabetes or low achieved LDL-C (<70 mg/dL). ApoB measurement helps identify adults with residual elevated lipoprotein-related risk that may be underestimated by the standard profile alone and may be useful in the diagnosis of specific lipid and lipoprotein disorders.9 PREVENT-ASCVD • Personalize risk assessment by considering 30-year ASCVD risk and ASCVD risk enhancers for patients at low risk (<3%) and borderline risk (3 to <5%).2 • For patients at low risk, consider moderate intensity lipidlowering therapy if LDL-C is 160-189 mg/dL or 30-year risk is ≥10% (ages 30 to 59).11 • Consider coronary artery calcium (CAC) scoring when treatment remains uncertain for patients with borderline risk (3 to <5%). CAC scoring in men at least 40 years of age and women at least 45 years of age can improve risk assessment and guide LDL-C and non-HDL-C goals. Both the absolute amount of CAC and the corresponding standardized percentile (currently based on age, sex and race) have prognostic importance and help to reclassify risk in adults.9 Consider moderate intensity lipid-lowering therapy if additional risk enhancers are present.11 • When 10-year predicted ASCVD risk using PREVENT-ASCVD Top Take-Home Messages for Clinicians Using the PREVENT- ASCVD Equations AHA RESOURCE: Top Take-Home Messages for Clinicians: CKM Syndrome AHA RESOURCE:
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