The Use of Risk-Enhancing Factors to Personalize ASCVD Risk Assessment: Evidence and Recommendations from the 2018 AHA/ACC Multi-Society Cholesterol Guidelines

Purpose of Review In 2018, the AHA/ACC Multi-Society Cholesterol Guidelines introduced the novel concept of risk-enhancing factors to be used as a supplement to the pooled cohort risk equations to personalize atherosclerotic cardiovascular disease risk assessment in primary prevention. In this review, we discuss the rationale and evidence behind each of the risk-enhancing factors to help clinicians perform a more personalized cardiovascular risk assessment. Recent Findings The risk-enhancing factors are high-risk features that may guide the use of lipid-lowering therapy particularly in intermediate and select borderline-risk patients. For the purpose of this review, these factors are divided into five categories: (i) race and genetics, (ii) conditions specific to women, (iii) lipid-related risk, (iv) concurrent high-risk medical conditions, and (v) biomarkers. Summary The addition of the risk-enhancing factors to the pooled cohort equations provides a more individualized and comprehensive approach to cardiovascular disease risk assessment.