• Mohammed Y Khanji, Vinícius V S Bicalho, Claudia N van Waardhuizen, Bart S Ferket, Steffen E Petersen, and M G Myriam Hunink.
• From Queen Mary University of London, London, United Kingdom; Federal University of Juiz de Fora School of Medicine, Juiz de Fora, Minas Gerais, Brazil; Erasmus Medical Center, Rotterdam, the Netherlands; and Icahn School of Medicine at Mount Sinai, New York, New York.
• Ann. Intern. Med. 2016 Nov 15; 165 (10): 713-722.

BackgroundMany guidelines exist for screening and risk assessment for the primary prevention of cardiovascular disease in apparently healthy persons.PurposeTo systematically review current primary prevention guidelines on adult cardiovascular risk assessment and highlight the similarities and differences to aid clinician decision making.Data SourcesPublications in MEDLINE and CINAHL between 3 May 2009 and 30 June 2016 were identified. On 30 June 2016, the Guidelines International Network International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and Web sites of organizations responsible for guideline development were searched.Study Selection2 reviewers screened titles and abstracts to identify guidelines from Western countries containing recommendations for cardiovascular risk assessment for healthy adults.Data Extraction2 reviewers independently assessed rigor of guideline development using the Appraisal of Guidelines for Research and Evaluation II instrument, and 1 extracted the recommendations.Data SynthesisOf the 21 guidelines, 17 showed considerable rigor of development. These recommendations address assessment of total cardiovascular risk (5 guidelines), dysglycemia (7 guidelines), dyslipidemia (2 guidelines), and hypertension (3 guidelines). All but 1 recommendation advocates for screening, and most include prediction models integrating several relatively simple risk factors for either deciding on further screening or guiding subsequent management. No consensus on the strategy for screening, recommended target population, screening tests, or treatment thresholds exists.LimitationOnly guidelines developed by Western national or international medical organizations were included.ConclusionConsiderable discrepancies in cardiovascular screening guidelines still exist, with no consensus on optimum screening strategies or treatment threshold.Primary Funding SourceBarts Charity.

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