30201-30211(1)

30201-30211(1) - Subclinical Atherosclerosis: Implications...

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Unformatted text preview: Subclinical Atherosclerosis: Implications for Cardiac Risk Assessment Nathan D. Wong, PhD, FACC Professor and Director Heart Disease Prevention Program Division of Cardiology University of CA, Irvine ATP III Assessment of CHD Risk For persons without known CHD, other forms of atherosclerotic disease, or diabetes: Count the number of risk factors: Cigarette smoking Hypertension (BP 140/90 mmHg or on antihypertensive medication) Low HDL cholesterol (<40 mg/dL) Family history of premature CHD CHD in male first degree relative <55 years CHD in female first degree relative <65 years Age (men 45 years; women 55 years) Use Framingham scoring for persons with 2 risk factors* (or with metabolic syndrome) to determine the absolute 10-year CHD risk. (downloadable risk algorithms at www.nhlbi.nih.gov) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA . 2001;285:2486-2497. 2001, Professional Postgraduate Services www.lipidhealth.org Note: Risk estimates were derived from the experience of the Framingham Heart Study, a predominantly Caucasian population in Massachusetts, USA. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA . 2001;285:2486-2497. Assessing CHD Risk in Men Step 1: Age Years Points 20-34-9 35-39-4 40-44 45-49 3 50-54 6 55-59 8 60-64 10 65-69 11 70-74 12 75-79 13 Step 2: Total Cholesterol TC Points at Points at Points at Points at Points at (mg/dL) Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79 <160 160-199 4 3 2 1 200-239 7 5 3 1 240-279 9 6 4 2 1 280 11 8 5 3 1 HDL-C (mg/dL) Points 60-1 50-59 40-49 1 <40 2 Step 3: HDL-Cholesterol Systolic BP Points Points (mm Hg) if Untreated if Treated <120 120-129 1 130-139 1 2 140-159 1 2 160 2 3 Step 4: Systolic Blood Pressure Step 5: Smoking Status Points at Points at Points at Points at Points at Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79 Nonsmoker Smoker 8 5 3 1 1 Age Total cholesterol HDL-cholesterol Systolic blood pressure Smoking status Point total Step 6: Adding Up the Points Point Total 10-Year Risk Point Total 10- Year Risk <0 <1% 11 8% 1% 12 10% 1 1% 13 12% 2 1% 14 16% 3 1% 15 20% 4 1% 16 25% 5 2% 17 30% 6 2% 7 3% 8 4% 9 5% 10 6% Step 7: CHD Risk ATP III Framingham Risk Scoring http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm 2001, Professional Postgraduate Services www.lipidhealth.org Modified approach to CHD risk assessment LOW RISK designated as <0.6% CHD risk per year (<6% in 10 years) INTERMEDIATE RISK designated as a CHD risk of 0.6%-2.0% per year (6-20% over 10 years) HIGH RISK designated as a CHD risk of >2% per year (20% in 10 years) (CHD risk equivalent), including those with CVD, diabetes, and PAD Greenland P et al. Circulation 2001; 104: 1863-7 Greenland P et al. Circulation 2001; 104: 1863-7 Presentation Examination: Height: 6 ft 2 in Weight: 220 lb (BMI 28 kg/m 2 )...
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This note was uploaded on 02/26/2012 for the course PHARM 210 taught by Professor Staff during the Fall '10 term at Rutgers.

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30201-30211(1) - Subclinical Atherosclerosis: Implications...

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