People following cholesterol values often ask what numbers are right for them. This is the second blog in a series to address this question.
As noted in the first blog, several additional questions must be answered before a conclusion can be reached:
Question 1 - What lipid / lipoprotein values should be used as goals?
Question 2 - What is the person's cardiovascular risk status (high-risk, moderate-risk, low-risk)?
Question 3 - What goals are appropriate for the level of cardiovascular risk present?
In this blog I will address Question 2 - What is the person's cardiovascular risk status?
Over the past two decades several cardiovascular risk categories have been advocated. The following represents a simplified grouping of patients into three groups - high-risk, moderate-risk, and low-risk.
"High-risk" status includes individuals with any of the following conditions:
- History of heart attack, stent, angioplasty, or bypass surgery;
- History of stroke, carotid (neck artery) stent or carotid endarterectomy (surgical removal of plaque from a carotid artery);
- Presence of coronary (heart), carotid, or peripheral artery (upper or lower extremity) atherosclerosis. Atherosclerosis, or "hardening of the arteries", may represent any clinically significant vascular wall thickening, "plaque", or "blockage;
- A condition that is associated with a 20 percent or higher risk of a heart attack over 10 years (Diabetes mellitus, Chronic kidney disease, or Abdominal aortic aneurysm);
- Individuals with 2 or more major risk factors (see below) and an estimated 20 percent or higher risk of a heart attack over 10 years using a standardized risk factor calculator (examples include the Framingham Risk Calculator, Reynolds Risk Score, MESA Risk Calculator);
- Individuals with a family history of early vascular disease (<55 years for males, < 65 years for females) in a primary family member (father, mother, brother, sister) as a single risk factor and a 20 percent or higher risk of a heart attack over 10 years using a standardized risk factor calculator;
- Patients diagnosed with Familial Hypercholesterolemia.
Note: Major risk factors include: Age (>45 years for men, >55 years for women); Active smoking; Hypertension (or on medication for high blood pressure); HDL cholesterol < 40; Family history of early vascular disease (<55 years for males, < 65 years for females) in a primary family member (father, mother, brother, sister).
Note: An additional category, "Very high-risk", is used for individuals at exceptionally elevated risk due to the presence of additional clinical factors beyond the 7 indicated above.
"Moderate-risk" status includes one of the following:
- Patients 2 or more major risk factors and an estimated 5 - 20 percent estimated risk of a cardiovascular event over the next 10 years using a standardized risk factor calculator;
- Patients with a family history of early vascular disease in a primary family member (father, mother, brother, sister) as a single risk factor and an estimated 5 - 20 percent estimated risk of a cardiovascular event over the next 10 years using a standardized risk factor calculator.
"Low-risk" status includes individuals with 0 - 1 risk factor (not including family history of early vascular disease) and less than an estimated 5 percent risk of a cardiovascular event over the next 10 years using a standardized risk factor calculator .
For each risk category (High-Risk, Moderate-Risk, Low-Risk) different specific LDL goals of therapy have been advocated. Overall, that the higher the cardiovascular risk, the lower the LDL target.
What is the recommended age to begin testing the LDL values? Would this be based on family history or current health issues or needs?
Posted by: Roberta M Rivera | 02/08/2012 at 10:42 PM