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).

• Cigarette smoking
  
  
• Hypertension:
  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 antihypertensive agents.
  
  
• High-risk low-density lipoprotein cholesterol:
  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 lipoprotein cholesterol:
  A low HDL-cholesterol is defined as a serum concentration of <35 mg/dL.
  
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• Impaired fasting glucose (IFG):
  The presence of clinical type 2 diabetes (fasting plasma glucose of 126 mg/dL or 2 hours postprandial plasma glucose of 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 CHD:
  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 relative.
  
  
• Age:
  Male 45 years
  Female 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, respectively.