Heart disease is the leading cause of death in the United States. An elevated level of low-density lipoprotein cholesterol is directly associated with development of atherosclerotic cardiovascular disease (ASCVD), which may present as coronary heart disease, stroke, and peripheral arterial disease.
It is estimated that approximately 71 million adults in the United States have elevated LDL-C, but less than half receive treatment, and only a third have LDL-C in the desired target level.
In 2013, the American College of Cardiology and the American Heart Association published cholesterol management guidelines, which are still the most current recommendations that address a comprehensive approach to prevent and reduce the risk of atherosclerotic cardiovascular disease.
These cholesterol guidelines encourage heart healthy lifestyle modifications and recommend 'statin' therapy in individuals who are at a high risk for atherosclerotic cardiovascular disease, which is one in every three adults in the United States.
Some find this part controversial, because many healthy people with good LDL-C values and no apparent disease are being recommended for 'statin' therapy on the basis of age alone.
Nevertheless, both ACC/AHA Guideline on the Assessment of Cardiovascular Risk and Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults are still widely used by medical community.
American College of Cardiology also tries to keep up with mobile technology by publishing and updating their guidelines, recommendations, and tools for iPhone and Android smartphones.
We already reviewed two apps developed and published by American College of Cardiology, first being Statin Intolerance app that help clinicians address 'statin' side effects, and the AnticoagEvaluator app, a stroke risk calculator that also provides guidance on antithrombotic therapy.
Another app we review today is the ASCVD Risk Estimator app, which is intended as a companion tool to the American College of Cardiology and the American Heart Association guidelines, with the main purpose to estimate a patient's 10-year and lifetime risk for atherosclerotic cardiovascular disease (ASCVD).
The app gets to the point right away and opens to the Estimator screen, which is basically a calculator that estimates the ASCVD risk based on the data you provide.
Users need to enter the gender, age, race, total cholesterol, HDL cholesterol, and systolic blood pressure. Also, the app requires users to indicate if they're on therapy for hypertension, if they have a history of diabetes, or if they're smoker.
Once you've completed data entry, estimation will be automatically displayed at the top of the screen, showing of 10-year and lifetime ASCVD risk. The estimation also displays, for comparison, the estimated risk for data entered with optimized risk factors.
You can tap on recommendation based on calculation to get individual recommendations on lifestyle modifications and 'statin' therapy. Usually, moderate to high-intensity 'statin' would be recommended to all individuals, unless their 10-year ASCVD risk is <5%.
Lifestyle modifications recommendations include eating a heart-healthy diet, exercising regularly, maintaining desirable body weight and avoiding tobacco products.
Entering data in calculator is simple, although there is no reset button, so you'd have to delete previously entered information manually.
Also, calculator caused iPhone to freeze. Unfortunately, re-installation of the app several times didn't help, so this remains a serious bug that prevents iPhone users from using the app.
Beside calculator, there are two other tabs that provide relevant ASCVD information. One tab is intended for clinicians and the other is for patients.
The Clinicians tab lists all relevant references for clinicians including understanding cardiovascular risk, lifestyle recommendations, groups that would benefit from statin therapy, statin safety recommendations, etc. Some sections such as recommendations for initiation of statin therapy, or how to monitor response to therapy include algorithms in form of diagrams. The information in Clinicians section is presented in concise format, usually as bullets that accentuate the main points.
The Patients tab provides helpful information in similar concise manner. Most of the information here originates from the CardioSmart patient portal that helps users with better understanding of their ASCVD risks, as well as of importance of lifestyle and behavioral changes like weight loss, smoking and dietary modifications.
About tab provides more information about the app, ACC/AHA guidelines and recommendations it's based on, as well as contributors.
I can only conclude that the ASCVD Risk Estimator app is great tool for getting a quick estimate of a patient's ASCVD risk that is useful for both patients and physicians. Physicians can use it to estimate the risk and to decide whether or not to start statin therapy, based on most current recommendations, while the patients can learn more about their risk and how to reduce it with lifestyle modifications.
I would definitely recommend this app to all clinicians, especially those who want to engage their patients in shared decision making and deliver better care based on authority guidelines and recommendations.
Benefit: Healthcare providers and patients who want to learn more about ASCVD risks