The 2019 ACC/AHA primary prevention guidelines acknowledge that 10-year risk scores can overestimate risk in older adults and underestimate risk in populations with social deprivation.

“the pooled cohort equation has never been tested in a randomized clinical fashion about treating People based on a full cohort equation cut Point versus another cut point that was never been tested you know the trials have specific enrollment criteria and they really weren't based on 10-year risk scores they were based on other factors and so this over-reliance on tenure risk scores but I will say that you have made some progress and I was really pleased I was a co-author on the 2019 ACC aha primary prevention guidelines we do acknowledge the limitations of these 10-year risk scores they can both overestimate risk in certain populations such as older adults and those with higher socioeconomic status and they can underestimate risk in other populations such as those with more social deprivation and these other unique risk factors that are not captured in these 10-year risk score”