Physicians' Academy for Cardiovascular Education

The ACC/AHA criteria for identification of very high-risk CVD patients have limited discriminative power

Identification of vascular patients at very high risk for recurrent cardiovascular events: validation of the current ACC/AHA very high risk criteria

Literature - van den Berg MJ, Bhatt DL, Kappelle LJ, et al. - Eur Heart J. 2017; published online ahead of print


The ESC, ACC/AHA and WHO guidelines for the prevention of cardiovascular disease (CVD) use different clinical criteria for the identification of patients at high or very high risk (VHR) for recurrent cardiovascular (CV) events. All patients with a history of CVD are considered as VHR according to the ESC and WHO guidelines, but the ACC/AHA guidelines classify patients as having a VHR only if besides CVD they additionally have diabetes, current smoking, dyslipidaemia or progression of coronary artery disease (CAD) [1-3].

In this analysis of the SMART study and the REACH registry, the prevalence and actual risk of recurrent CV events according to the ACC/AHA VHR criteria were evaluated. Moreover, the performance of the ACC/AHA VHR criteria was compared with this of other single very high-risk factors (low eGRF, polyvascular disease, abdominal aortic aneurysm, peripheral artery disease, progression of CAD, smoking, high age, diabetes) in contemporary cohorts of patients with clinically manifest arterial disease.

Main results


In the SMART study and the REACH registry, single very high risk factors or simple criteria, such as the ACC/AHA VHR criteria, had limited discriminative power to identify patients at highest risk of recurrent MACE. These findings suggest that there is a need to improve the identification of very high-risk patients in the secondary CVD prevention.


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Find this article online at Eur Heart J

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