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Coronary heart disease (CHD)

Coronary heart disease (CHD) risk equivalents

Risk factors for developing coronary heart disease

Cholesterol treatment goals, CHD, and CHD-associated risk factors

Lifetime risk of developing coronary heart disease

Total/HDL-C ratio and 20-year risk for developing CHD

Framingham 10-year risk evaluation for developing cardiovascular events

Reynolds Risk Score

Coronary heart disease (CHD)

An individual described as having CHD has a history of a myocardial infarct, 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 (CHD) risk equivalents

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 mellitus, and two or more risk factors with a 10-year risk for hard CHD above 20% (according to the 10-year Framingham risk score).

Risk factors for developing coronary heart disease

Cigarette smoking, hypertension (BP >140/90 mm Hg or on antihypertensive medication), low high-density lipoprotein (HDL) cholesterol (<40 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) are major risk factors for developing CHD.

Cholesterol treatment goals, CHD, and CHD-associated risk factors

This information outlines treatment goals for individuals at different levels of CHD risk.

Risk category
LDL-C goal
Initiate TLC
High risk: CHD or CHD risk equiv. (10-year risk > 20%)
<100 mg/dL
(optional goal: < 70 mg/dL)
>100 mg/dL
Moderate high risk: 2+ risk factors (10-year risk 10%-20%)
<130 mg/dL
>130 mg/dL
Moderate risk: 2+ risk factors (10-year risk < 10%)
<130 mg/dL
>130 mg/dL
Lower risk: 0-1 risk factor
<160 mg/dL
>160 mg/dL

LDL-C = Low-density lipoprotein cholesterol TLC = Therapeutic lifestyle change

Lifetime risk of developing coronary heart disease

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.

Men Women
Age <200 201-239 >240 <200 201-239 >240
40 31.3 42.9 57.3 15.4 26.0 32.9
50 40.1 41.7 62.7 19.2 29.7 39.0
60 33.9 41.1 50.8 19.5 24.1 35.6
70 26.6 36.0 41.7 13.8 19.5 29.4
80 17.4 22.7 34.2 16.6 17.5 21.2

 

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.

Men Women
Age <200 201-239 >240 <200 201-239 >240
40 31.3 42.9 57.3 15.4 26.0 32.9
50 40.1 41.7 62.7 19.2 29.7 39.0
60 33.9 41.1 50.8 19.5 24.1 35.6
70 26.6 36.0 41.7 13.8 19.5 29.4
80 17.4 22.7 34.2 16.6 17.5 21.2

Total/HDL-C ratio and 20-year risk for developing CHD

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.

Men Women
Age <3.8 3.8-5.8 >5.9 <2.9 2.9-4.5 >4.6
40 5.4 10.0 20.1 0.5 3.7 8.8
50 7.5 19.7 30.9 2.4 5.4 14.5
60 16.4 29.3 42.9 9.9 13.9 20.8
70 20.6 32.0 44.0 7.2 17.6 25.9
80 16.3 18.6 36.2 0 18.5 21.9

 

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.

Men Women
Age <3.8 3.8-5.8 >5.9 <2.9 2.9-4.5 >4.6
40 5.4 10.0 20.1 0.5 3.7 8.8
50 7.5 19.7 30.9 2.4 5.4 14.5
60 16.4 29.3 42.9 9.9 13.9 20.8
70 20.6 32.0 44.0 7.2 17.6 25.9
80 16.3 18.6 36.2 0 18.5 21.9

Framingham 10-year risk evaluation for developing cardiovascular events

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.

Reynolds Risk Score

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

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