Table 6:

Risk stratification: New or updated recommendations in the 2018 C-CHANGE harmonized guideline*

RecommendationSource guideline (key supporting reference)
We recommend that a cardiovascular risk assessment be completed every 5 yr for men and women aged 40 to 75 yr using the modified FRS or CLEM to guide therapy to reduce major cardiovascular events. A risk assessment might also be completed whenever a patient’s expected risk status changes.CCS34
We recommend calculating and discussing a patient’s “cardiovascular age” to improve the likelihood that patients will reach lipid targets and that poorly controlled hypertension will be treated. We recommend sharing the results of the risk assessment with the patient to support shared decision-making and improve the likelihood that patients will reach lipid targets.CCS34
  • Note: C-CHANGE = Canadian Cardiovascular Harmonized National Guidelines Endeavour, CCS = Canadian Cardiovascular Society – Dyslipidemia, CLEM = Cardiovascular Life Expectancy Model, FRS = Framingham Risk Score.

  • * All recommendations are considered strong recommendations (Box 1); the quality of evidence supporting each recommendation varies (see Appendix 1, available at, for a detailed discussion of the supporting evidence. Key references are indicated in this table.)