Measurement of C-reactive protein, another hot topic, is rated class III (no benefit) in asymptomatic adults who are defined as high-risk by the Adult Treatment Panel III standard of a greater than 20% 10-year risk. Similarly, CRP is class III in low-risk men younger than age 50 and in low-risk women younger than age 60.
However, CRP is beneficial in fine-tuning risk assessment in individuals who are at intermediate 10-year risk based upon their global assessment. CRP gets a class IIa recommendation as a guide to deciding on statin therapy in men aged 50 or older and in women aged 60 and older with an LDL cholesterol level of less than 130 mg/dL. It gets a class IIb recommendation in asymptomatic men and women aged 50 and 60 years, respectively, or younger.
Other tests that are rated class IIa or IIb under various circumstances in intermediate-risk people include ankle-brachial index testing for peripheral artery disease, a resting ECG in patients with hypertension or diabetes, conventional echocardiography in hypertensive patients, an exercise ECG before the start of a vigorous exercise program, carotid intima-media thickness measurement when performed by an expert operator, and measurement of hemoglobin A1c. Testing for microalbuminuria gets a class IIa recommendation in asymptomatic adults with diabetes or hypertension, and is class IIb for intermediate-risk adults without those comorbidities.
The full 54-page guideline was released online in Circulation during the conference.
Dr. Smith declared having no relevant financial interests. Dr. Greenland disclosed serving as a consultant to Pfizer, General Electric, and Toshiba.