From this perspective, it is essential to quantify the patient s prognosis as accurately as possible. Several ap- proaches to estimating the risk of cardiovascular mortality or events are provided later in this guideline. In the absence of an established prognostic model, the following considerations are highlighted: 1. Sociodemographic characteristics: Age is the single strongest determinant of survival, whereas ethnicity and sex have conflicting and less important effects on risk. Lower socioeconomic status also is associated with 2. Cardiovascular risk factors: Smoking, hypertension, dyslipidemia, family history of premature CAD, obe- sity, and sedentary lifestyle confer a greater risk of complications. 3. Coexisting medical conditions: Diabetes mellitus,230 chronic kidney disease (CKD),231 chronic pulmonary disease, and malignancy are the most important noncar- diac conditions to influence prognosis.232 234 4. Cardiovascular comorbidities: Heart failure, PAD, and cerebrovascular diseases are strong prognostic risk fac- tors for mortality. 5. Psychosocial characteristics: Depression repeatedly has been demonstrated to be strongly and independently associated with worse survival, and anxiety has also been implicated.235 242 Poor social support, poverty, and stress also are associated with adverse 6. Health status: Patients symptoms, functional capacity, and quality of life are associated significantly with survival and the incidence of subsequent ACS.246,247 In a large, prospective cohort of patients in the Veterans Affairs healthcare system, physical limitations due to angina were second only to age in predicting 7. Anginal frequency: Frequency of angina is a very strong predictor of subsequent ACS hospitalizations.246 8. Cardiac disease severity: The degree and distribution of stenoses measured by coronary angiography, findings on exercise testing and stress imaging, and LV function measured with a variety of technologies all provide meaningful prognostic information that supplements more clinical information. 3.1.2. 