Mohammed Y. Khanji, MB, BCh; Vinícius V.S. Bicalho, MD; Claudia N. van Waardhuizen, MSc; Bart S. Ferket, PhD; Steffen E. Petersen, DPhil; M.G. Myriam Hunink, PhD
Grant Support: By a large project grant from the Barts Charity for the HAPPY (Heart Attack Prevention Programme for You) London study (reference number 437/1412).
Disclosures: Dr. Hunink reports personal fees (royalties) from Cambridge University Press, grants and nonfinancial support from European Society of Radiology, and nonfinancial support from European Institute for Biomedical Imaging Research outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1110.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Not applicable. Data set: See Tables 1 and 2; Appendix Tables 1, 2, 3 and 4; and the Appendix Figure. Other information (for example, a list of excluded articles available) is available from Dr. Hunink (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: M.G. Myriam Hunink, MD, PhD, Erasmus Medical Center, Room Na-2818, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e-mail, email@example.com.
Current Author Addresses: Drs. Khanji and Petersen: Queen Mary University London, Charterhouse Square, London EC1M 6BQ, United Kingdom.
Dr. Bicalho: University of Juiz de Fora School of Medicine, Rua José Lourenço Kelmer, Martelos s/n, Juiz de Fora, Minas Gerais 36036-330, Brazil.
Ms. van Waardhuizen and Dr. Hunink: Erasmus Medical Center, Room Na-2818, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Dr. Ferket: Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029.
Author Contributions: Conception and design: M.Y. Khanji, V.V.S. Bicalho, B.S. Ferket, S.E. Petersen, M. Hunink.
Analysis and interpretation of the data: M.Y. Khanji, C.N. van Waardhuizen, B.S. Ferket, S.E. Petersen.
Drafting of the article: M.Y. Khanji, C.N. van Waardhuizen.
Critical revision of the article for important intellectual content: M.Y. Khanji, B.S. Ferket, S.E. Petersen, M. Hunink.
Final approval of the article: M.Y. Khanji, V.V.S. Bicalho, B.S. Ferket, S.E. Petersen, M. Hunink.
Provision of study materials or patients: M.Y. Khanji.
Administrative, technical, or logistic support: M.Y. Khanji, S.E. Petersen.
Collection and assembly of data: M.Y. Khanji, V.V.S. Bicalho.
Khanji MY, Bicalho VV, van Waardhuizen CN, Ferket BS, Petersen SE, Hunink MM. Cardiovascular Risk Assessment: A Systematic Review of Guidelines. Ann Intern Med. 2016;165:713-722. doi: 10.7326/M16-1110
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Published: Ann Intern Med. 2016;165(10):713-722.
Published at www.annals.org on 13 September 2016
Many guidelines exist for screening and risk assessment for the primary prevention of cardiovascular disease in apparently healthy persons.
To systematically review current primary prevention guidelines on adult cardiovascular risk assessment and highlight the similarities and differences to aid clinician decision making.
Publications in MEDLINE and CINAHL between 3 May 2009 and 30 June 2016 were identified. On 30 June 2016, the Guidelines International Network International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and Web sites of organizations responsible for guideline development were searched.
2 reviewers screened titles and abstracts to identify guidelines from Western countries containing recommendations for cardiovascular risk assessment for healthy adults.
2 reviewers independently assessed rigor of guideline development using the Appraisal of Guidelines for Research and Evaluation II instrument, and 1 extracted the recommendations.
Of the 21 guidelines, 17 showed considerable rigor of development. These recommendations address assessment of total cardiovascular risk (5 guidelines), dysglycemia (7 guidelines), dyslipidemia (2 guidelines), and hypertension (3 guidelines). All but 1 recommendation advocates for screening, and most include prediction models integrating several relatively simple risk factors for either deciding on further screening or guiding subsequent management. No consensus on the strategy for screening, recommended target population, screening tests, or treatment thresholds exists.
Only guidelines developed by Western national or international medical organizations were included.
Considerable discrepancies in cardiovascular screening guidelines still exist, with no consensus on optimum screening strategies or treatment threshold.
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Cardiology, Coronary Risk Factors, Prevention/Screening.
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