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Diagnosis and Assessment of Disease Table 2. Risk Categories 10-Year CHD Risk8-14, a High Risk Any one of the following: 1. History of CVD event (acute coronary syndrome, myocardial infarction [MI], coronary revascularization [percutaneous transluminal coronary angioplasty, stent, coronary artery bypass graft], cerebrovascular accident, carotid revascularization [stent, endarterectomy]) 2. CHD risk equivalent diagnosis (DM, chronic kidney disease, peripheral vascular disease, abdominal aortic aneurysm) 4. Coronary calcium score > 400 or presence of carotid plaquec 3. Two or more risk factors (RF) and > 20% estimated 10-year CHD risk Note: Combination of any 10-year High- Risk Criteria PLUS one of the following enhances risk: ▶ 2 or more RF ▶ 1 or more poorly controlled RF ▶ Metabolic syndrome plus CHD equivalent ▶ Elevated Lp(a). More aggressive targets may be considered based on clinical judgment Moderate Risk Any one of the following: 1. Family history of CHD in 1st degree relative < age 55 male or < age 65 female 2. Two or more RF with 5-20% 10-year CHD risk Note: Presence of 2 or more RF with 10-20% 10-year CHD risk may prompt selection of more aggressive targets based on clinical judgment. Low Risk 0-1 RF (not including family history early CHD) with < 5% 10-year CHD risk Ideal values for all of the following:b 1. TC < 180 2. HDL-C male > 40 or female > 50 3. Non-smoker 4. Untreated BP < 120 systolic and < 80 diastolic 5. Non-diabetic 6. BMI < 25.0d 7. No family history of CHD in 1st degree relative < age 55 male or < age 65 female. a 10-year CHD risk calculated using a validated risk assessment method (Framingham, Reynolds, MESA). b c Increased risk present in multiple prospective observational trials. 8 d Lifetime risk modeled in Framingham Heart Study using values at age 50 in disease free adults. Lifetime risk modeled in meta-analysis of 257,384 men and women whose cardiovascular risk factors were measured at the ages of 45, 55, 65, and 75 years. Any one of the following in a non-smoking, non- diabetic subject: 1. Family history of CHD in 1st degree male relative < age 55 or female < age 65 2. Untreated BP 120-139 systolic or 80-89 diastolic.b 3. BMI > 25.0d 4. HDL-C < 40 men or < 50 womenb Note: Presence of BMI > 30d BP 140-159 or diastolic BP 90-99, further enhances risk. , or untreated systolic More aggressive targets may be considered based on clinical judgment Lifetime CHD Risk9, 15-18, b Any one of the following: 1. History of CVD event (acute coronary syndrome, MI, coronary revascularization [percutaneous transluminal coronary angioplasty, stent, coronary artery bypass graft], cerebrovascular accident, carotid revascularization [stent, endarterectomy]) or familial 2. Any CHD risk equivalent diagnosis (DM, chronic kidney disease, peripheral vascular disease, abdominal aortic aneurysm) 3. Metabolic syndromec hypercholesterolemiac 4. Any of the following single risk factors:d ▶ TC > 240 mg/dL or treated hypercholesterolemia 5. Subclinical vascular disease (detected by invasive, or noninvasive [carotid plaque; coronary calcium score or CIMT > 75th percentile following adjustment for age, gender, ethnicity], imaging studies)c ▶ Treated hypertension (HTN) or untreated systolic > 160 or diastolic > 100 ▶ Active smoking Note: Combination of any Lifetime High-Risk Criteria PLUS one of the following further enhances risk: ▶ 2 or more RF ▶ Metabolic syndrome plus CHD equivalent ▶ Elevated Lp(a). More aggressive targets may be considered based on clinical judgment