For a patient concerned about heart disease with an ASCVD risk score of 5.6%, which risk-enhancer is most appropriate to evaluate?

In assessing a patient's cardiovascular risk, various risk enhancers can provide crucial additional insights, particularly when a patient's ASCVD risk score is around the threshold where decision-making becomes nuanced. Given a patient with an ASCVD risk score of 5.6%, evaluating family history of premature atherosclerotic cardiovascular disease is particularly useful.

Family history can significantly affect individual risk, as genetic predispositions to heart disease can occur. A family history of premature ASCVD, specifically events occurring before age 55 in male relatives and 65 in female relatives, can indicate a heightened risk for the patient that may not be fully captured by standard risk assessments. Therefore, obtaining this information can guide clinicians in determining the need for more aggressive risk-reduction strategies or interventions.

Other risk-enhancers, while relevant in certain contexts, may not be as directly impactful in the assessment of this specific patient population. The ankle-brachial index measurement, for instance, helps evaluate peripheral arterial disease but may not be the most pertinent risk enhancer in this scenario. Similarly, screening for albuminuria is typically more associated with diabetes management or chronic kidney disease. Lastly, serum calcium concentration can aid in coronary artery disease assessment, but it is not as widely recognized as a primary risk enhancer compared