Table 1. Table 1. Summary of steps involved in assessing risks.
| STEPS ADAPTED FROM GUIDELINES3 | Mr X | Mr Y |
|---|---|---|
| Step 1 : Determine lipoprotein levels | Borderline HDL-C | Elevated serum cholesterol and low HDL-C. |
| Step 2: Identify presence of clinical atherosclerotic diseases that confers high risk for coronary artery disease eventsa | None | None. |
| Step 3: Determine presence of major risk factorsb | Two major risk factors: low HDL-C; age (>45 years). | One major risk factor: the low HDL-C. |
| Step 4: If 2+ risk factors are present without CHD, assess 10-year (short-term) CHD risk using Framingham tables (see reference 3) | Score of 8, equivalent to a 10-year risk of 4%. | Not applicable as he has only one major risk factor. |
| Steps 5-7: Determine risk category, and establish the target LDL | Not available | |
| Step 8: Identify metabolic syndrome and treat, if present after 3 months of therapeutic lifestyle change | Thus the importance of measuring if waist circumference | |
| Step 9: Treat elevated TG based on levels with appropriate LDL, non-HDL cholesterol targets. For TG, 1.7 -2.26 mmols/L = borderline high; 2.27-5.64 mmol/L = high and > 5.65 mmol/L = very high | TG 4.7 mmol/L. Requires only lifestyle change. | TG 17.0 mmol/L. First lower TG. Lifestyle changes, with drugs (fibrates, nicotinic acid or fish oils). |
| Step 10: Goals for LDL <3.36 mmol/L for 2+ risk factors and 10-year risk ≤ 20% <4.14 mmol/L for 0-1 risk factors | Recheck LDL later. Goal <3.36 mmol/L | Recheck LDL later. Goal <4.14 mmol/L |
| Step 11: Goals for non-HDL-C <4.14 mmol/L for 2+ risk factors and 10-year risk ≤ 20% <4.91 mmol/L for 0-1 risk factors | Non-HDL-C is 3.9 mmol/L. Has reached goal of <4.14 mmol/L | Non-HDL-C 6.6.mmol/L. Aim to reduce to <4.91 mmol/L |
| Step 12: Goals for HDL-C >1.0 mmol/L | Already achieved | HDL-C 0.5 mmol/L. Aim to increase to above 1 mmol / L |
aDiseases that that confer high risk for events: clinical coronary heart disease, symptomatic carotid artery disease, peripheral arterial disease, abdominal aneurysm, and diabetes
bMajor risk factors: cigarette smoking, BP ≥140/90 or on antihypertensive, low HDL (<1mmol / L), family history of premature coronary heart disease (first degree relatives male ≤55 years and female ≤65 years), age ≥45 years for males and ≥ 55 years for females