Identification of Cardiovascular Risk
Factors That Impart a High Absolute Risk
Patients can be classified as
being at high absolute risk for obesity-related disorders if they have three or
more of the multiple risk factors listed below. The presence of high absolute
risk increases the intensity of cholesterol lowering therapy (142) and blood pressure management (545).
A patient is classified as having hypertension if systolic blood pressure is
140 mm Hg or diastolic blood pressure is
90 mm Hg, or if the patient is taking
High-risk low-density lipoprotein
A high-risk LDL-cholesterol is
defined as a serum concentration of
160 mg/dL. A borderline high-risk
LDL-cholesterol (130 to 159 mg/dL) together with two or more other risk factors
also confers high risk.
- Low high-density
A low HDL-cholesterol is defined
as a serum concentration of <35 mg/dL.
- Impaired fasting glucose
The presence of clinical type 2
diabetes (fasting plasma glucose of
126 mg/dL or 2 hours postprandial plasma
200 mg/dL) is a major risk factor for CVD, and
its presence alone places a patient in the category of very high absolute risk.
IFG (fasting plasma glucose 110 to 125 mg/dL) is considered by many authorities
to be an independent risk factor for cardiovascular (macrovascular) disease,
justifying its inclusion among risk factors contributing to high absolute risk.
Although including IFG as a separate risk factor for CVD departs from the ATP
II and JNC VI reports, its inclusion in this list may be appropriate. IFG is
well established as a risk factor for type 2 diabetes.
- Family history of premature
A positive family history of
premature CHD is defined as definite myocardial infarction or sudden death at
or before 55 years of age in the father or other male first-degree relative, or
at or before 65 years of age in the mother or other female first-degree
55 years (or postmenopausal)
Methods for estimating
absolute risk status for developing CVD based on these risk factors are
described in detail in the ATP II and JNC VI reports. The intensity of
intervention for high blood cholesterol or hypertension is adjusted depending
on the absolute risk estimated by these factors. Approaches to therapy for
cholesterol disorders and hypertension are described in the ATP II and JNC VI,