Table 6.

Risk-Enhancing Factors for Clinician–Patient Risk Discussion

Risk-Enhancing Factors

Family history of premature ASCVD (males, age <55 y; females, age <65 y)

Primary hypercholesterolemia (LDL-C, 160–189 mg/dL [4.1-4.8 mmol/L); non-HDL-C 190–219 mg/dL [4.9–5.6 mmol/L])*

Metabolic syndrome (increased waist circumference, elevated triglycerides [>175 mg/dL], elevated blood pressure, elevated glucose, and low HDL-C [<40 mg/dL in men; <50 in women mg/dL] are factors; tally of 3 makes the diagnosis)

Chronic kidney disease (eGFR 15–59 mL/min/1.73 m2 with or without albuminuria; not treated with dialysis or kidney transplantation)

Chronic inflammatory conditions such as psoriasis, RA, or HIV/AIDS

History of premature menopause (before age 40 y) and history of pregnancy-associated conditions that increase later ASCVD risk such as preeclampsia

High-risk race/ethnicities (eg, South Asian ancestry)

Lipid/biomarkers: Associated with increased ASCVD risk

Persistently* elevated, primary hypertriglyceridemia (≥175 mg/dL);

If measured:

1. Elevated high-sensitivity C-reactive protein (≥2.0 mg/L)

2. Elevated Lp(a): A relative indication for its measurement is family history of premature ASCVD. An Lp(a) ≥50 mg/dL or ≥125 nmol/L constitutes a risk-enhancing factor especially at higher levels of Lp(a).

3. Elevated apoB ≥130 mg/dL: A relative indication for its measurement would be triglyceride ≥200 mg/dL. A level ≥130 mg/dL corresponds to an LDL-C ≥160 mg/dL and constitutes a risk¬ enhancing factor

4. ABI <0.9

^*Optimally, 3 determinations.

AIDS indicates acquired immunodeficiency syndrome; ABI, ankle-brachial index; apoB, apolipoprotein B; ASCVD, atherosclerotic cardiovascular disease; eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; HIV, human immunodeficiency virus; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein (a); and RA, rheumatoid arthritis.