Cardiovascular Disease (Traditional Risk Markers) - Risk Markers - CVD (Traditional)

Cardiovascular Disease (Traditional Risk Markers) - Risk Markers - CVD (Traditional)

 

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in the U.S.

Risk factors for CVD

  • Elevated low density lipoprotein (LDL) cholesterol
  • Tobacco smoking
  • Hypertension (140/90 mmHg or on medication for hypertension)
  • Low high density lipoprotein (HDL) cholesterol <40 mg/dL
  • Family history of premature CVD (CVD in first degree male relative <55 years old; CVD in first female degree relative <65 years old)
  • Aging

Basis of risk assessment

  • Statins have been demonstrated to reduce LDL concentrations and reduce cardiovascular mortality in numerous trials
  • Determination of which patients benefit from drug therapy is important for early prevention and intervention
  • Adult Treatment Panel (ATP) III guidelines (Framingham Study)
    • Identify patients at risk for development of CVD
    • Develop plan of action for at risk patients with target goals for LDL and triglycerides (TG)

Diagnosis and Treatment

  • ATP III Recommendations (for adults >20 years old, obtain lipid testing every 5 years)
  • Determine lipoprotein concentrations using fasting lipid testing (LDL-C, HDL and TG are the minimum recommendation)
  • Identify risk factors present for CVD (see list above)
  • If >2 risk factors present, assess Framingham projections for 10 year CVD risk
    • 20% 10 year risk by Framingham criteria is considered a CVD equivalent risk factor
  • Click here for additional information on the ATP III Guidelines and Framingham assessment
  • Determine final risk category for treatment goals
    • High risk – patients with CVD or CVD equivalent (diabetes or >20% 10 year risk)
      • Target LDL-C is <100 mg/dL (optional <70mg/dL)
    • Intermediate risk – patients with 2 or more risk factors and 10 year risk <20%
      • Target LDL-C is <130 mg/dL
    • Low risk  – patients with fewer than 2 risks are low risk
      • Target LDL-C is <160 mg/d
  • Initiate lifestyle modifications and/or drug therapy to reduce LDL-C to target concentrations
  • High TG (>150 mg/dL)
    • Lifestyle modifications
    • If TG ≥200 mg/dL, non-HDL-C target is 30 mg/dL higher than LDL-C target

Disease Monitoring

  • After 3 months of lowering attempts of LDL-C, assess for presence of metabolic syndrome
    • Criteria for metabolic syndrome  – waist circumference >40 inches (male), >35 inches (female); TG ≥150 mg/dL; HDL-C <40 mg/dL (male), <50 mg/dL (female); fasting glucose ≥100 mg/dL
    • If the patient meets criteria for metabolic syndrome, consider LDL-C target concentration <100 mg/dL

See Also