13
ASCVD Risk Enhancers:
• Family history of premature ASCVD
• Persistently elevated LDC-C
≥160 mg/dL (≥4.1 mmol/L)
• Chronic kidney disease
• Metabolic syndrome
• Conditions specific to women (e.g.,
preeclampsia, premature menopause)
• Inflammatory diseases (especially
rheumatoid arthritis, psoriasis, HIV)
• Ethnicity (e.g., South Asian ancestry)
Lipid/Biomarkers:
• Persistently elevated triglycerides
(≥175 mg/dL, [≥2.0 mmol/L])
In selected individuals if measured:
• hs-CRP ≥2.0 mg/L
• Lp(a) levels >50 mg/dL or >125 nmol/L
• Apo-B ≥130 mg/dL
• Ankle-brachial index (ABI) <0.9
Table 4. Risk-Enhancing Factors for Clinician–Patient Risk
Discussion
• Family history of premature ASCVD (males, age <55 y; females, age <65 y)
• Primary hypercholesterolemia (LDL-C, 160–189 mg/dL [4.1–4.8 mmol/L); non–
HDL-C 190–219 mg/dL [4.9–5.6 mmol/L])
a
• Metabolic syndrome (increased waist circumference, elevated triglycerides [>175
mg/dL], elevated blood pressure, elevated glucose, and low HDL-C [<40 mg/dL in
men; <50 in women mg/dL] are factors; tally of 3 makes the diagnosis)
• Chronic kidney disease (eGFR 15–59 mL/min/1.73 m
2
with or without
albuminuria; not treated with dialysis or kidney transplantation)
• Chronic inflammatory conditions such as psoriasis, RA, or HIV/AIDS
• History of premature menopause (before age 40 y) and history of pregnancy-
associated conditions that increase later ASCVD risk such as preeclampsia
• High-risk race/ethnicities (e.g., South Asian ancestry)
• Lipid/biomarkers: Associated with increased ASCVD risk
▶ Persistently
a
elevated, primary hypertriglyceridemia (≥175 mg/dL);
▶ If measured:
» Elevated high-sensitivity C-reactive protein (≥2.0 mg/L)
» Elevated Lp(a): A relative indication for its measurement is family history of
premature ASCVD. An Lp(a) ≥50 mg/dL or ≥125 nmol/L constitutes a risk-
enhancing factor especially at higher levels of Lp(a).
» Elevated apoB ≥130 mg/dL: A relative indication for its measurement would be
triglyceride ≥200 mg/dL. A level ≥130 mg/dL corresponds to an LDL-C >160
mg/dL and constitutes a risk-enhancing factor
» ABI <0.9
a
Optimally, 3 determinations.
Figure 2. Primary Prevention Notes
