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Atherosclerotic cardiovascular disease risk prediction: current state-of-the-art
  1. Amit Rout1,
  2. Sanchit Duhan2,
  3. Muhammad Umer1,
  4. Miranda Li3,
  5. Dinesh Kalra1
  1. 1 Cardiology, University of Louisville, Louisville, Kentucky, USA
  2. 2 Cardiology, Sinai Health System, Baltimore, Maryland, USA
  3. 3 Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr Dinesh Kalra, University of Louisville, Louisville, KY 40202, USA; dinesh.kalra{at}

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Learning objectives

  • Understand atherosclerotic cardiovascular disease (ASCVD) risk scores and how and when to use them.

  • Appreciate the differences among the major risk assessment models and select the best tool for each patient.

  • Identify traditional and newer risk factors associated with ASCVD.

  • Appreciate the future of large-model risk prediction calculators and individualised decision-making tools.


Cardiovascular disease (CVD) is the leading cause of mortality worldwide, resulting in ~18 million deaths annually.1 Atherosclerotic CVD (ASCVD) accounts for four out of every five cardiovascular (CV) deaths, one-third of which are premature.1 From 2010 to 2020, there was a global increase of ~19% in CV deaths.1 The economic burden of CVD on the European economy exceeds €200 billion annually.2 The United Nations has set a target of 25% reduction in premature mortality from CVD by 2025, primarily through earlier detection and better preventive strategies.

Current guidelines recommend using standardised risk estimation tools (or calculators) for primary prevention in individuals without known ASCVD—this allows both the treating provider and the patient to understand their short-term and lifetime risk of developing ASCVD and its complications such as death, myocardial infarction (MI) and stroke, and also helps classify the population into different risk categories to match the treatment intensity to the gradient of CV risk.3 4

Standardised risk calculators are superior to aggregating individual risk factors when estimating overall risk. These calculators are weighted for various risk factors, and rigorously validated and calibrated for the specific target population. Different risk calculators and models exist for different populations worldwide (figure 1). The oldest such model was derived from a cohort in Framingham, USA, with subsequent iterations including PCEs (pooled cohort equations) (currently used in the USA). In Europe, several similar models exist including QRISK3 (QRESEARCH cardiovascular risk algorithm 3) in the UK and the latest European Union …

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  • X @DineshKalra

  • Contributors All authors (SD, AR, ML, MU and DK) have contributed to the intellectual content of the paper, drafting and revision of the paper, and have approved the final submission. SD and DK designed the figures and the table.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.