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Table 13. Risk Enhancers
Risk Enhancers
• History of premature ASCVD in a parent or sibling (onset age <55 y for men, <65 y
for women)
• Higher risk ancestry (eg, South Asian, Filipino)
• High polygenic risk (if measured) (Section 4.2.3.5, "Polygenic Risk Scores")
• Chronic inflammatory diseases (eg, systemic lupus, rheumatoid arthritis, advanced
psoriasis, inflammatory arthritis)
• Lp(a) ≥125 nmol/L or ≥50 mg/dL
• hsCRP ≥2 mg/L on >1 occasion (if measured)
• TG persistently ≥175 mg/dL (2 mmol/L) (if nonfasting ) and ≥150 mg/dL
(1.7 mmol/L) (if fasting )
• CKM syndrome
• LDL-C persistently ≥160–189 mg/dL (4.1–4.9 mmol/L), non–HDL-C≥190–219
mg/dL or apoB ≥120 mg/dL*
• Reproductive risk markers (premature menopause, preeclampsia, gestational diabetes,
gestational hypertension, preterm delivery; Section 4.2.3.4, "Reproductive Risk Marker")
Note that all available information should be included in risk estimates derived from the
PREVENT-ASCVD equations, including albuminuria, HbA1c, and zip code for assessment
of neighborhood-level social determinants of health. Given the recent publication of the
PREVENT-ASCVD equations, it remains to be demonstrated for most risk enhancers that
risk is incremental to the PREVENT-ASCVD equations.
* Although LDL-C is not included in the PREVENT-ASCVD equations (total cholesterol
and HDL-C are included), it is included here because persistent elevation of LDL-C may be
a useful factor to include in risk-benefit discussions about LDL-C–lowering therapy, given
that it is the target of that therapy. See Section 4.2.3.4, "Reproductive Risk Marker," for more
detail regarding reproductive risk factors.
ApoB indicates apolipoprotein B; ASCVD, atherosclerotic cardiovascular disease; CKM,
cardiovascular-kidney-metabolic; HbA1c, hemoglobin A1c; HDL-C, high-density
lipoprotein-cholesterol; hsCRP, high-sensitivity C-reactive protein; LDL-C, low-density
lipoprotein-cholesterol; Lp(a), lipoprotein (a); and TG, triglycerides.
Adapted with permission from Grundy et al. Copyright © 2018 American Heart Association,
Inc. and American College of Cardiolog y Foundation.
