Goal 2: Reduce Human Disease

Should clinical primary prevention of ASCVD be guided by subclincal disease or estimated risk?

Current approaches to guiding use of clinical primary prevention interventions, e.g., statins and aspirin, are based on treating patients who exceed a specific risk threshold. The performance of risk estimation is good, but not outstanding, and results from clinical and population studies continue to support the value of new biomarkers. Given the widespread use of preventive therapies, the lack of untreated cohorts is a major barrier to observational evaluation of new risk assessment approaches and biomarkers. A randomized trial is needed to test whether clinical primary prevention interventions are more cost-effectively guided by data on presence of subclinical disease (e.g., coronary artery calcium by CT) than by estimated risk.

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Idea No. 546