What Laboratory Numbers Are Right For Me? Part 2

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:

1. History of heart attack, stent, angioplasty, or bypass surgery;
2. History of stroke, carotid (neck artery) stent or carotid endarterectomy (surgical removal of plaque from a carotid artery);
3. 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;
4. 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);
5. 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);
6. 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;
7. 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:

1. 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;
2. 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.

Comments

[Roberta M Rivera]

What is the recommended age to begin testing the LDL values? Would this be based on family history or current health issues or needs?