An individual described as having CHD has a history of a myocardial infarction, or heart attack, unstable angina, or stable angina, has had a coronary artery procedure (angioplasty or bypass surgery), or has evidence of clinically significant myocardial ischemia.
Coronary heart disease risk equivalents include manifestations of non-coronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and carotid artery disease (transient ischemic attacks or stroke of carotid origin or 50% obstruction of a carotid artery), diabetes, and two or more risk factors with a 10-year risk for hard CHD above 20% (according to the 10-year Framingham risk score).
- cigarette smoking
- hypertension (BP >140/90 mm Hg or taking antihypertensive medication)
- low high-density lipoprotein cholesterol (HDL-C) (<40 mg/dL), high low-density lipoprotein cholesterol (LDL-C) 160-189mg/dl; high non-HDL-C 190-219mg/dL, triglycerides ≥175 mg/dL (see cholesterol treatment goals and Cholesterol Levels).
- high-sensitivity C-reactive protein ≥2.0mg/dL; elevated lipoprotein (a) ≥50 mg/dL or ≥125 nmol/L; elevated apolipoprotein B ≥130 mg/dL
- family history of premature CHD (CHD in male first-degree relative <55 years of age; CHD in female first-degree relative <65 years of age), and age (men >45 years; women >55 years)
- metabolic syndrome
- chronic kidney disease
- chronic inflammatory conditions (e.g., rheumatoid arthritis, psoriasis, HIV disease)
- history of pre-eclampsia or early menopause
- high-risk ethnicity (e.g. South Asian Ancestry)
- ankle-brachial index (ABI) ‹0.9
This information outlines treatment goals for individuals at different levels of CHD risk.
|Risk category||Initiate TLC|
|High risk: CHD or CHD risk equiv. (10-year risk > 20%)|
(optional goal: < 70 mg/dL)
|Moderate high risk: 2+ risk factors (10-year risk 10%-20%)|
|Moderate risk: 2+ risk factors (10-year risk < 10%)|
|Lower risk: 0-1 risk factor|
LDL-C = Low-density lipoprotein cholesterol TLC = Therapeutic lifestyle change
Example 1: A 55-year-old male with a total cholesterol of 220 mg/dL has a 41.7% risk of developing CHD during his lifetime.
Example 2: A 55-year-old female with a total cholesterol of 220 mg/dL has a 29.7% risk of developing CHD during her lifetime.
Example 1: A 55-year-old male with a total cholesterol of 220 mg/dL and a high-density lipoprotein cholesterol (HDL-C) of 50 mg/dL (220/50=4.4) has a 19.7% risk of developing coronary heart disease (CHD) in 20 years.
Example 2: A 55-year-old female with a total cholesterol of 220 mg/dL and a HDL-C of 50 mg/dL (220/50=4.4) has a 5.4% risk of developing coronary heart disease (CHD) in 20 years.
This evaluation estimates the 10-year risk for the development of a myocardial infarction and coronary death. The Framingham Risk Calculator is designed to quantify the risk in adults aged 20 and older who do not have heart disease or diabetes.
The Reynolds Risk Score is designed to predict your risk of having a future heart attack, stroke, or other major heart disease in the next 10 years in individuals who are considered healthy and without diabetes. Reynolds Risk Score Calculator
- Framingham Risk Score Calculator to Estimate the 10-year Risk for Developing a Cardiovascular Event. Estimates 10-year risk of heart attack.
- Reynolds Risk Score for Cardiovascular Risk in Women. Estimates 10-year cardiovascular risk in women over age 45 years.
- 2018 Prevention Guidelines Tool CV Risk Calculator To estimate a patient’s 10-year atherosclerotic cardiovascular disease (ASCVD) risk at an initial visit to establish a reference point.
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