13 A Toolkit for Healthcare Professionals is intermediate (3% to <10%), consider CAC scoring to evaluate for subclinical atherosclerosis in the setting of treatment uncertainty.2, 11 • LLT for primary prevention of ASCVD is reasonable for adults with a 10-year PREVENT-ASCVD risk estimate of 3% to <5%, and is recommended for those at 5% to <10%, after a clinician-patient discussion.2,9 • Consider LLT when 10-year predicted ASCVD risk using PREVENT-ASCVD is 3% to <5% after evaluating risk enhancers, 30-year ASCVD risk or CAC scoring in select individuals when there is treatment uncertainty.11 • Initiate LLT when 10-year predicted ASCVD risk using PREVENT-ASCVD is high (≥10%).11 • Measure lipoprotein(a) at least once to identify patients at higher risk of ASCVD. It’s considered a risk-enhancing factor at levels ≥125 nmol/L (50 mg/dL), which is associated with about a 1.4-fold increase in ASCVD risk, and values ≥250 nmol/L (100 mg/dL) are associated with ≥2-fold higher estimated risk. The presence of elevated Lp(a) should indicate more intensive LDL-C lowering and management of other risk factors.9 PREVENT-HF Consider cardiac biomarker testing, such as B-type natriuretic peptide (BNP), N-terminal pro b-type natriuretic peptide (NT-proBNP) or high-sensitivity cardiac troponin (hs-cTn) and/or transthoracic echocardiogram (TTE) when 10-year predicted HF risk using PREVENT-HF is increased (≥5%) and use preventive therapies as indicated.11 For patients with pre-HF as indicated by biomarker/TTE, use lifestyle modification and coordinated care to intensify preventive therapies as indicated.2 Use of Predicted Risk and Expected Benefit to Guide Decision-Making in Cardiovascular-KidneyMetabolic Syndrome for the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology AHA SCIENTIFIC STATEMENT: Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology | Hypertension AHA SCIENTIFIC STATEMENT:
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