The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Cardiovascular Risk Assessment: A Systematic Review of GuidelinesCardiovascular Risk Assessment ONLINE FIRST

Mohammed Y. Khanji, MB, BCh; Vinícius V.S. Bicalho, MD; Claudia N. van Waardhuizen, MSc; Bart S. Ferket, PhD; Steffen E. Petersen, DPhil; and M.G. Myriam Hunink, PhD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 13 September 2016.

From Queen Mary University of London, London, United Kingdom; Federal University of Juiz de Fora School of Medicine, Juiz de Fora, Minas Gerais, Brazil; Erasmus Medical Center, Rotterdam, the Netherlands; and Icahn School of Medicine at Mount Sinai, New York, New York.

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, m.hunink@erasmusmc.nl).

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, m.hunink@erasmusmc.nl.

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.

Ann Intern Med. Published online 13 September 2016 doi:10.7326/M16-1110
© 2016 American College of Physicians
Text Size: A A A

Background: Many guidelines exist for screening and risk assessment for the primary prevention of cardiovascular disease in apparently healthy persons.

Purpose: To systematically review current primary prevention guidelines on adult cardiovascular risk assessment and highlight the similarities and differences to aid clinician decision making.

Data Sources: 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.

Study Selection: 2 reviewers screened titles and abstracts to identify guidelines from Western countries containing recommendations for cardiovascular risk assessment for healthy adults.

Data Extraction: 2 reviewers independently assessed rigor of guideline development using the Appraisal of Guidelines for Research and Evaluation II instrument, and 1 extracted the recommendations.

Data Synthesis: 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.

Limitation: Only guidelines developed by Western national or international medical organizations were included.

Conclusion: Considerable discrepancies in cardiovascular screening guidelines still exist, with no consensus on optimum screening strategies or treatment threshold.

Primary Funding Source: Barts Charity.


Grahic Jump Location
Appendix Figure.

Summary of the guideline search and review process.

The number of guidelines at each step is indicated. AGREE II = Appraisal of Guidelines for Research and Evaluation II.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.