Description

A number of factors enter into the discussion between clinician and patient about lipid-lowering therapy. There are a group of risk-enhancing factors that may favor a more aggressive approach.


Factors that may increase a patient's risk for atherosclerotic cardiovascular disease (ASCVD):

(1) family history of premature ASCVD (age < 55 years for males, < 65 years for females)

(2) primary hypercholesterolemia (LDL-cholesterol 160-189 mg/dL; non-HDL cholesterol 190-219 mg/dL)

(3) metabolic syndrome

(4) chronic kidney disease, with eGFR 15-59 mL per min per 1.73 sq meter with or without albuminuria, not treated with dialysis and not post kidney transplant

(5) chronic inflammatory conditions (rheumatoid arthritis, psoriasis, HIV, etc)

(6) history of premature menopause (< 40 years of age) and history of pregnancy-associated conditions associated with ASCVD (pre-eclampsia)

(7) high-risk ethnicity (South Asian, other)

(8) biomarkers with increased risk

(9) ankle-to-brachial index < 0.9

 

Biomarkers associated with increased risk:

(1) persistently elevated primary hypertriglyceridemia (>= 175 mg/dL)

(2) elevated serum high-sensitivity CRP (>= 2 mg/L)

(3) elevated serum lipoprotein(a) (>= 50 mg/dL)

(4) elevated serum apoB (>= 130 mg/dL)


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