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Blood Cholesterol

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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

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