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Cholesterol Testing & CHD Risk
|Synonyms||HDL cholesterol; LDL cholesterol; Coronary risk panel; Coronary artery disease; Coronary heart disese; CAD|
|Additional information|| The classification of the risk of heart disease should be based upon the average of 2-3 sets of measurements taken 1-8 weeks apart, in addition to non-cholesterol factors. CHD risk equivalents, as defined in the NIH National Cholesterol Education Panel Adult Treatment Program III (NCEP-ATPIII) guidelines, include: diabetes; clinically significant atherosclerotic disease; or multiple risk factors conferring a 10 year CHD risk of > 20% by Framingham Point Score calculation. Click here for latest recommendations
ATPIII LDL Goals (adapted from Circulation 2004; 110(2):236)
Risk Category LDL treatment goals
High risk: CHD or CHD risk equivalents (10-year risk > 20%) goal < 100 mg/dL
(optional goal: < 70 mg/dL)
Moderately high risk: 2+ risk factors (10-year risk 10-20%) goal < 130 mg/dL
(optional goal: < 100 mg/dL)
Moderate risk: 2+ risk factors (10-year risk < 10%) goal < 130 mg/dL
Lower risk: 0-1 risk factors < 160 mg/dL
After considering LDL treatment goals and therapeutic life style changes, assessment of the metabolic syndrome and additional treatment goals for triglycerides and HDL cholesterol should be addressed as described in the ATPIII guidelines.
Estimating the risk of atherosclerotic heart disease from the ratio of total/HDL cholesterol is no longer recommended by many experts, who believe that HDL cholesterol is most useful when employed as part of the assay for LDL Cholesterol rather than by itself. Others believe that the ratio of total/HDL cholesterol may better predict coronary risk (high risk males: > 6.0-7.0; high risk females: > 5.6-6.0). Still others believe that the most useful measurement is perhaps non-HDL Cholesterol (Total Cholesterol - HDL Cholesterol), the cholesterol in all lipoprotein particles containing apolipoprotein B, including VLDL. The measurement of non-HDL Cholesterol does not require fasting and does not rely upon assumptions of the Friedewald formula.
Non-HDL Cholesterol values for adults (> 19 y/o):
The value of non-HDL Cholesterol is discussed in NEJM. 1995;332:1491 and the ATPIII guidelines.
|Last Updated||11/12/2013 8:44:25 AM|