Table 3.

Suggested clinical Applications of Measurements of LAS in primordial and primary prevention of cardiovascular disease

	Clinical Scenario	Rationale	Impact on Clinical Management
Hypertension	ACC/AHA Stage 1 Hypertension (130–139/80–89 mmHg) with PCE-calculated 10-year ASCVD risk ~10% without diabetes or CKD	LAS can be useful to refine risk stratification when PCE-calculated 10-year ASCVD risk is close to the threshold for treatment, after an informed clinician-patient discussion.	Initiation of pharmacologic antihypertensive therapy
	Stage 2 isolated systolic hypertension (>140 mmHg) in very young adults with paucity of other cardiovascular risk factors	The combination of high pulse pressure amplification (with normal central systolic pressure) and low or normal LAS for age support a low CV risk	Withholding of pharmacologic antihypertensive therapy
	Non-hypertensive adults <40 years of age with a family history of ISH	LAS is partially heritable. LAS precedes and predicts the development of ISH, a potentially avoidable threshold in the life course of cardiovascular disease (see Figure 14B). A high PWV for age is consistent with early vascular aging.	Guide clinician-patient risk discussions. Intensification of lifestyle interventions. More frequent assessments of cardiovascular risk before age 40 (<4–6 years)
Other CV Risk Assessment Scenarios	Refinement of cardiovascular risk assessment in non-diabetic adults 40–75 years of age at intermediate PCE-calculated 10-year ASCVD risk	In this group of patients, risk-based decisions for preventive interventions may be uncertain and LAS measurements can be utilized to refine risk assessment (particularly if various “risk enhancing” clinical parameters do not clearly favor a specific course of action).	Guide clinician-patient risk discussion Guide decision-making regarding initiation of pharmacologic therapy (i.e., statins)
	Refinement of cardiovascular risk assessment in middle-aged non-diabetic adults at borderline PCE-calculated 10-year risk of ASCVD (5% to <7.5%) who also have other factors that increase their ASCVD risk (“risk enhancers”)	In this group of patients, LAS measurements may be useful to improve risk-based decisions as an alternative or as a “gate-keeper” for coronary calcium score testing, particularly when concerns about radiation exposure (younger age, overweight/obesity) or about cost are present	Guide clinician-patient risk discussion. Guide decision-making regarding further testing (coronary calcium score) or initiation of therapy (i.e, statins)
	Assessment of CV risk in special populations	PCE-calculated 10-year risk estimations can provide notoriously mis-calibrated estimates in non-US populations, particularly those at earlier stages of the epidemiologic transition. This may also apply to immigrants from those populations in the US.	Guide clinician-patient risk discussions and various interventions An abnormal PWV for age indicates subclinical arterial damage and suggests a higher-risk. Expert clinical judgement must guide result interpretation and decision-making depending on the specific clinical scenario.

ASCVD= atherosclerotic cardiovascular disease; CV=cardiovascular; PCE=pulled cohort equations.