The 2018 and 2019 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of so-called "risk-enhancing factors" in borderline to intermediate risk individuals. These include high-risk race/ethnicity (e.g. South Asian origin), chronic kidney disease, a family history of premature ASCVD, the metabolic syndrome, chronic inflammatory disorders (e.g. rheumatoid arthritis [RA], psoriasis, or chronic human immunodeficiency virus [HIV]), and conditions specific to women, among others. Studies suggest, however, that risk may be highly heterogeneous within these subgroups. The AHA/ACC guidelines also recommend consideration of coronary artery calcium (CAC) scoring for further risk assessment in borderline to intermediate risk individuals in whom management is uncertain. Although the combination of risk enhancing factors and CAC burden (together with Pooled Cohort estimates) may lead to more accurate ASCVD risk assessment, few publications have closely examined the interplay between risk enhancing factors and CAC scoring for personalized risk estimation. Our aim is to review the relevant literature in this area. Although further research is clearly needed, CAC assessment seems a highly valuable option to inform individualized ASCVD risk management in these important, often highly heterogeneous patient subgroups.

中文翻译：

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根据2019 AHA / ACC一级预防指南，对重要患者亚群中的个体心血管风险进行冠状动脉钙化评分。

美国心脏病学会和美国心脏病学会（AHA / ACC）的2018年和2019年关于动脉粥样硬化性心血管疾病（ASCVD）一级预防的指南建议在中等风险人群中考虑所谓的“风险增强因素”。这些包括高风险的种族/民族（例如，来自南亚的血统），慢性肾脏疾病，过早的ASCVD的家族病史，代谢综合征，慢性炎症性疾病（例如类风湿性关节炎[RA]，牛皮癣或慢性人类免疫缺陷病毒[HIV] ]），以及女性特有的条件等。然而，研究表明，这些亚组中的风险可能高度不同。AHA / ACC指南还建议考虑对冠心病患者进行不确定的中度风险个体的边缘风险评估，以考虑冠状动脉钙化（CAC）评分。尽管将风险增强因素和CAC负担结合起来（与合并队列估计一起使用）可能会导致更准确的ASCVD风险评估，但很少有出版物仔细检查了风险增强因素与CAC评分之间的相互关系以进行个性化风险评估。我们的目的是回顾该领域的相关文献。尽管显然需要进一步的研究，但在这些重要的，往往高度异类的患者亚组中，CAC评估似乎是指导个性化ASCVD风险管理的极有价值的选择。尽管风险增强因素和CAC负担的组合（与合并队列估计一起）可能会导致更准确的ASCVD风险评估，但很少有出版物仔细检查了风险增强因素与CAC评分之间的相互关系以进行个性化风险评估。我们的目的是回顾该领域的相关文献。尽管显然需要进一步的研究，但CAC评估似乎是在这些重要的，往往高度异类的患者亚组中为个性化ASCVD风险管理提供信息的极有价值的选择。尽管将风险增强因素和CAC负担结合起来（与合并队列估计一起使用）可能会导致更准确的ASCVD风险评估，但很少有出版物仔细检查了风险增强因素与CAC评分之间的相互关系以进行个性化风险评估。我们的目的是回顾该领域的相关文献。尽管显然需要进一步的研究，但CAC评估似乎是在这些重要的，往往高度异类的患者亚组中为个性化ASCVD风险管理提供信息的极有价值的选择。