Clinical Management of LDL Quantity
ÎConventionally, the National Cholesterol Education Program Adult Treatment Panel Guidelines (NCEP ATP, published in 2002 with a 2004 update) have advocated use of LDL-C and non-HDL-C (defined as TC minus HDL-C), lipid surrogates of atherogenic particle number (apoB or LDL-P), as targets of therapy.
ÎIn response to newer data and recommendations from expert panels, clinicians are shifting emphasis to particle measures of LDL quantity, such as apoB or NMR LDL particle number (LDL-P).
ÎAn integrated practical application of these recommendations is summarized in the following steps:
Step 1: Assess Both 10-Year and Lifetime Cardiovascular Risk8-18
ÎSeveral validated methods have been advocated to estimate an individual's cardiovascular risk based on a combination of clinical history and selected biomarkers.
• Short-term risk (10-year risk) can be estimated by the Framingham Risk Score (http://hp2010.nhlbihin.net/atpiii/calculator.asp) (See Appendix C), Reynolds Risk Score (http://www.reynoldsriskscore.org/default.aspx), and MESA (Multi- Ethnic Study of Atherosclerosis) Score (http://www.mesa-nhlbi.org/Calcium/ ArterialAge.aspx).
• Long-term risk reflects the increased cardiovascular risk present among younger individuals with chronic exposure to punitive risk factors or high-risk disease states.
Framingham Risk Score
Reynolds Risk Score
MESA Score
ÎIntegrating short- and long-term risk estimates provides a superior strategy to correctly classify an individual's cardiovascular risk status.
• Because cardiovascular risk is cumulative over time, 10-year risk often underestimates the long-term risk inherent in the same clinical factors.
• To optimize individual management, clinicians should adopt targets appropriate for the highest short- or long-term risk category associated with the clinical factors present.
ÎConsider additional laboratory or noninvasive imaging studies (such as carotid intima-media thickness [CIMT] or coronary calcium score) to further assess CVD risk.
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