Risk Assessment
3
Table 2. Major Risk Factors for ASCVD
a
1. Age
Male ≥45 years
Female ≥55 years
2. Family history of early CHD
b
<55 years of age in a male first-degree relative, or
<65 years of age in a female first-degree relative
3. Current cigarette smoking
4. High blood pressure (≥140/≥90 mm Hg, or on blood pressure medication)
5. Low HDL-C
Male <40 mg/dL
Female <50 mg/dL
a
Levels of non-HDL-C and LDL-C are not listed, because these risk factors are used to assess risk
category and treatment goals for atherogenic lipoprotein cholesterol levels. (See Table 4) Diabetes
mellitus is not listed because it is considered a high or very high risk condition for ASCVD risk
assessment purposes.
b
CHD is defined as myocardial infarction (MI), coronary death, or a coronary revascularization
procedure.
Risk Assessment
Î Risk category is used both for the purpose of defining treatment goals
for atherogenic cholesterol (as well as apo B) and for defining the
level of atherogenic cholesterol elevation at which pharmacotherapy to
lower atherogenic cholesterol levels might be considered.
Î As an option for those with 2 major ASCVD risk factors, the clinician
may wish to perform quantitative risk scoring to estimate 10-year or
long-term/lifetime risk for an ASCVD or coronary heart disease (CHD)
event (See Table 3) and may also consider other risk indicators based
on additional testing.
• It should be noted that the risk scoring thresholds are not intended to indicate
"statin benefit groups."
Table 3. Risk Calculators
High Risk Threshold
a
Adult Treatment Panel III Framingham
• http://cvdrisk.nhlbi.nih.gov/calculator.asp
≥10% 10-year risk for a hard CHD
event (MI or CHD death)
Pooled Cohort Equations (American College
of Cardiology/American Heart Association)
• http://tools.cardiosource.org/ASCVD-Risk-
Estimator/
≥15% 10-year risk for a hard
ASCVD event (MI, stroke or death
from CHD or stroke)
Framingham long-term (30-year to age 80)
• http://tools.cardiosource.org/ASCVD-Risk-
Estimator/
≥45% risk for CVD (MI, CHD
death or stroke)
a
ese thresholds identify "high risk " individuals and are not intended to indicate "statin benefit"
groups.
