USPSTF Issues Recommendation Statements on Risk Assessments for Cardiovascular Disease
August 30, 2018—The US Preventive Services Task Force (USPSTF) recently announced the publication of two final recommendation statements and evidence summaries on the prevention of cardiovascular disease (CVD) in Journal of the American Medical Association: (1) "Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index" (2018;320:177–183) and (2) "Risk Assessment for Cardiovascular Disease with Nontraditional Risk Factors" (2018;320:272–280).
In the first, the USPSTF concluded that the current evidence is insufficient and that the balance of benefits and harms of screening for peripheral artery disease with the ankle-brachial index (ABI) in asymptomatic adults cannot be determined. This final recommendation statement updates and is consistent with the 2013 recommendation statement, advised the USPSTF.
In the USPSTF announcement, Task Force member Seth Landefeld, MD, stated, "We know that the ABI can be used for diagnosis of PAD in people with symptoms. However, the Task Force looked at whether it can be used to identify the risk of developing blocked vessels in the leg among people without signs or symptoms of PAD. At this time, there is not enough evidence to recommend for or against using the ABI as a screening tool.”
In the second, the USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score in assessing risk for CVD in asymptomatic adults to prevent CVD events. This final recommendation updates and is consistent with the 2009 recommendation statement.
Task Force member Michael Barry, MD, commented in the announcement, "While there is some evidence that the ABI, CAC, and hsCRP can provide clinicians with additional information on risk, we could not determine whether this was enough to help clinicians make better treatment or care decisions. More research is needed to know if adding these three tests for nontraditional risk factors to CVD risk assessment can help improve our ability to prevent heart attack or stroke.”
Both of these statements are grade I recommendations, in which the balance of benefits and harms cannot be determined. These recommendation statements are also available on the Task Force's website.