For primary prevention, patients with mixed dyslipidemia beginning therapy, first determine their risk factors other than LDL-C for coronary heart disease (CHD)1
The major positive risk factors include
- Current Cigarette smoking
- Hypertension (BP ≥ 140/90 mmHg* or on antihypertensive medication)
- Low HDL cholesterol (<40 mg/dL*)
- Family history of premature CHD (CHD in male first-degree relative <55 years; CHD in female first-degree relative <65 years)
- Age (men ≥45 years; women ≥55 years)
* Confirmed by measurements on several occasions
HDL-C ≥ 60 mg/dL counts as a "negative" risk factor; its presence removes one risk factor from the total count
NCEP ATP III's primary approach to risk assessment for persons without CHD or CHD risk equivalents is to count the number of major risk factors for CHD.
A next step for your patients with multiple (2+) risk factors is to calculate the Framingham 10-year risk score.
This tool is useful to (a) identify patients who have a 10 year risk >20 percent (CHD risk equivalent), and (b) identify patients with borderline high LDL-C and have a 10 year risk of 10–20 percent. Both groups are candidates for more intensive LDL-lowering therapy than was recommended in ATP II.
Framingham Risk Calculator
The Framingham Risk Calculator can help you evaluate your patient's risk of CHD over the next 10 years. When you input your patient’s history and lab values, this useful interactive tool estimates risk. To use the Framingham risk estimate you will need a patient's age, total cholesterol, smoking status, HDL-C level, and systolic blood pressure.
Reference:
- National Heart, Lung, and Blood Institute. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Institutes of Health; 2002. NIH publication 02-5215.
