Table 3.

Summary of guidelines

Screening	United States Preventive Services Task Force Guideline (Evidence Grade)a	American College of Cardiology Foundation/American Heart Association Guideline (Evidence Grade)b	Other Guidelines
Global Risk Assessment		The race- and sex- specific Pooled Cohort Equations should be used in non-Hispanic African Americans and non-Hispanic Whites 40 to 79 years of age (B) Use of the sex-specific Pooled Cohort Equations for non-Hispanic Whites may be considered when estimating risk in patients from populations other than African Americans and non-Hispanic Whites (C) It is reasonable to assess traditional ASCVD risk factors (Age, sex, total and HDL-cholesterol, systolic blood pressure, use of antihypertensive therapy, diabetes, and current smoking) every 4 to 6 years in adults 20 to 79 years of age who are free from ASCVD (B) Assessing 30-year or lifetime ASCVD risk based on traditional risk factors may be considered in adults 20 to 59 years of age without ASCVD and who are not at high short- term risk (C)33
Genetic Screening		Genotype testing for CHD risk assessment in asymptomatic adults is not recommended (B)66	National Institute for Health and Clinical Excellence: Recommends cascade screening with both cholesterol and DNA testing for the diagnosis of FH69
Blood Pressure	Recommends screening for high blood pressure in adults aged 18 and older (A)70	Blood pressure screening is not specifically addressed; however, blood pressure is included in the Pooled Cohort Equation recommended for estimating risk33	Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: Blood pressure screening is not specifically addressed15
Blood Tests
Lipids	Strongly recommends FLP screening men aged 35 and older for lipid disorders (A) Recommends FLP screening men aged 20 to 35 for lipid disorders if they have additional risks, such as smoking, HTN, or diabetes (B) Strongly recommends FLP screening women aged 45 and older (A) Recommends FLP screening women aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease, such as smoking, HTN, or diabetes (B) No recommendation for or against routine screening for lipid disorders in men aged 20 to 35, or in women aged 20 and older who are not at increased risk for coronary heart disease (C)71	Measurement of lipid parameters beyond a standard FLP (total cholesterol, HDL, LDL, triglycerides) are not recommended in asymptomatic adults (C)66	National Cholesterol Education Program (NCEP) ATP-III: Recommends a complete FLP (total cholesterol, LDL, HDL, and triglycerides) as the preferred initial test, rather than screening for total cholesterol and HDL alone Recommends screening all adults age 20 years and older every 5 years, or more frequently with a borderline result44
High Sensitivity CRP	Current evidence is insufficient to the balance of benefits and harms of using nontraditional risk factors to screen asymptomatic men and women with no history of CHD to prevent CHD events (I)72	If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of high sensitivity CRP may be considered to inform treatment decision making (B)33	American College of Preventive Medicine (ACPM): Does not recommend routine screening of the general adult population using high sensitivity CRP73 NCEP ATP-III: Does not recommend routine measurement of inflammatory markers for the purpose of modifying LDL- cholesterol goals in primary prevention.44
Homocysteine	Current evidence is insufficient to the balance of benefits and harms of using nontraditional risk factors to screen asymptomatic men and women with no history of CHD to prevent CHD events (I)72	Not addressed	NCEP ATP-III: Does not recommend routine measurement of homocysteine as part of risk assessment to modify LDL- cholesterol goals for primary prevention44
Imaging
CAC Score	Current evidence is insufficient to the balance of benefits and harms of using nontraditional risk factors to screen asymptomatic men and women with no history of CHD to prevent CHD events (I)72	If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of CAC score may be considered to inform treatment decision making (B)33	NCEP ATP-III: Does not recommend indiscriminate screening for CAC in asymptomatic persons, particularly in persons without multiple risk factors Measurement of CAC is an option for advanced risk assessment in appropriately selected persons44 ACPM: Does not recommend routine screening of the general adult population using computed tomography scanning73
cIMT	Current evidence is insufficient to the balance of benefits and harms of using nontraditional risk factors to screen asymptomatic men and women with no history of CHD to prevent CHD events (I)72	cIMT is not recommended for routine measurement in clinical practice for risk assessment for first ASCVD event (B)33	ACPM: Does not recommend routine screening of the general adult population using cIMT73
Ultrasound of Abdominal Aorta	Recommends one- time screening for AAA by ultrasonography in men aged 65 to 75 years who have ever smoked (B) No recommendation for or against screening for AAA in men aged 65 to 75 years who have never smoked (C) Recommends against routine screening for AAA in women (D) 74	Not addressed	ACPM: Recommends one- time AAA screening in men aged 65-75 years who have ever smoked Routine AAA screening in women is not recommended73
ECG
Stress	Recommends against routine screening with exercise treadmill test in adults with low risk for CHD events (D)75	An exercise ECG may be considered for cardiovascular risk assessment in intermediate-risk asymptomatic adults (including sedentary adults considering starting a vigorous exercise program), predominantly when attention is paid to non- ECG markers such as exercise capacity (B)66	ACPM: Does not recommend routine screening of the general adult population using exercise-stress testing 73
Resting	Insufficient evidence to recommend for or against routine ECG in adults at increased risk for CHD events (I)75	A resting ECG is reasonable for cardiovascular risk assessment in asymptomatic adults with HTN or diabetes (C) A resting ECG may be considered for cardiovascular risk assessment in asymptomatic adults without HTN or diabetes (C)66	ACPM: Does not recommend routine screening of the general adult population using ECG73

^aStrength of recommendation. Grade A: The USPSTF recommends the service. There is high certainty that the net benefit is substantial. Grade B: The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Grade C: The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Grade D: The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. I: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.⁶⁵

^bEvidence based on certainty of treatment effect. Level A: Multiple populations evaluated, data derived from multiple randomized clinical trials or meta-analyses. Level B: Limited populations evaluated, data derived from a single randomized trial or nonrandomized study. Level C: Very limited populations evaluated, only consensus opinion of experts, case studies, or standards of care.⁶⁶

AAA: abdominal aortic aneurism; ASCVD: atherosclerotic cardiovascular disease; ATP-III: Adult Treatment Panel III; cIMT: carotid intima-media thickness; CAC: coronary artery calcium; CHD: coronary heart disease; CRP: c-reactive protein; FH: familial hypercholesterolemia; FLP: fasting lipid panel; HDL: high-density lipoproteins; HTN: hypertension; LDL: low-density lipoproteins