Assessment of Cardiovascular Risk Recommendations for Assessment of Cardiovascular Risk Referenced studies that support recommendations are summarized in Online Data Supplement 3. COR LOE Recommendations I B-NR For adults 40 to 75 years of age, clinicians should routinely assess traditional cardiovascular risk factors and calculate 10-year risk of ASCVD by using the pooled cohort equations (PCE).S2.2-1,S2.2-2 IIa B-NR For adults 20 to 39 years of age, it is reasonable to assess traditional ASCVD risk factors at least every 4 to IIa B-NR In adults at borderline risk (5% to <7.5% 10-year ASCVD risk) or intermediate risk), it is reasonable to use additional risk-enhancing factors to guide decisions about preventive interventions (eg, statin IIa B-NR In adults at intermediate risk ( 7.5% to <20% 10-year ASCVD risk) or selected adults at borderline risk (5% to <7.5% 10- year ASCVD risk), if risk-based decisions for preventive interventions (eg, statin therapy) remain uncertain, it is reasonable to measure a coronary artery calcium score to guide clinician patient risk IIb B-NR For adults 20 to 39 years of age and for those 40 to 59 years of age who have <7.5% 10-year ASCVD risk, estimating lifetime or 30-year ASCVD risk may be Among adults at borderline (5% to <7.5%) and inter- mediate ( 7.5% to <20%) risk, one may consider ad- ditional individual risk-enhancing clinical factors (Table 3) that can be used to revise the 10-year ASCVD risk These factors may include having a fam- ily history of premature ASCVD,S2.2-5 chronic inflam- matory disease [rheumatoid arthritis,S2.2-6 or ], South Asian ancestry,S2.2-13 a his- tory of preeclampsiaS2.2-8 or preterm delivery,S2.2-9 early chronic kidney disease (CKD), metabolic syndrome, persis- tently elevated inflammatory markers,S2.2-14 or elevat- ed lipid biomarkers.S2.2-4 After these clinically available risk-enhancing factors have been considered, if there is still uncertainty about the reliability of the risk es- timate for individuals in the borderline- or interme- diate-risk categories, further testing to document subclinical coronary atherosclerosis is reasonable to more accurately reclassify the risk estimate upward or Table 3. 