USPSTF 2018: insufficient evidence to recommend nontraditional risk factors for CVD screening (I statement)

Reference

US Preventive Services Task Force, Curry SJ, Krist AH, et al. Risk assessment for cardiovascular disease with nontraditional risk factors. US Preventive Services Task Force recommendation statement. JAMA 2018;320(3):272-280.

Synopsis

The USPSTF found no acceptable evidence evaluating patient-oriented benefits of CVD risk assessment with nontraditional risk factors, including ankle-brachial index, high-sensitivity C-reactive protein level, and coronary artery calcium score. Available evidence addressing the effect of coronary artery calcium score screening found no improvement in preventive medication use or risk factor management compared with traditional CVD risk assessment. Two studies comparing aspirin therapy and 2 studies comparing exercise therapy addressed the treatment of asymptomatic adults with a low ankle-brachial index. None of these studies reported any significant difference in CVD events, mortality, development of peripheral artery disease (PAD) symptoms, PAD revascularization procedures, amputations, or improved quality of life. No direct evidence of harm was found, but potential harms include false positive tests and resultant anxiety, exposure to radiation and incidental findings from chest imaging leading to further invasive testing and procedures, disease labeling, and unnecessary costs. The American College of Cardiology and the American Heart Association recommend the use of 1 or more nontraditional risk factors to help clarify borderline treatment decisions. Neither the Canadian, European, UK, nor Scottish guidelines recommend including nontraditional risk factors to guide decision making.