From the Guidelines
The risk of Atherosclerotic Cardiovascular Disease (ASCVD) can be quantified using the Pooled Cohort Equations, which estimate 10-year ASCVD risk based on factors such as age, sex, cholesterol levels, blood pressure, diabetes status, and smoking status. The following table summarizes the risk of ASCVD from various risk factors:
- Age: risk approximately doubles every decade after age 55 1
- Sex: men have 1.5-2 times higher risk than premenopausal women 1
- Smoking: increases risk by 2-4 times compared to non-smokers 1
- Hypertension: contributes 2-3 times increased risk, with each 20 mmHg increase in systolic blood pressure raising risk by about 30% 1
- Cholesterol levels: each 39 mg/dL increase in LDL cholesterol associated with a 20-30% higher risk 1
- Diabetes mellitus: doubles to quadruples risk, with poor glycemic control further elevating this risk 1
- Family history of premature ASCVD: increases risk by 1.5-2 times 1
- Obesity: particularly central obesity, raises risk by 1.5-2 times 1
- Physical inactivity: contributes a 1.5-2.5 times increased risk 1
- Chronic kidney disease: increases risk by 1.5-3 times depending on severity 1 According to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, the 10-year ASCVD risk can be categorized as follows:
- Low risk: <5% 1
- Borderline risk: 5% to 7.4% 1
- Intermediate risk: 7.5% to 19.9% 1
- High risk: ≥20% 1 The ACC/AHA guidelines also recommend considering additional factors, such as family history of premature ASCVD, LDL-C levels, metabolic syndrome, chronic kidney disease, and high-risk ethnicity, to personalize risk assessment and guide treatment decisions 1. The use of the Pooled Cohort Equations and consideration of additional risk factors can help clinicians estimate 10-year ASCVD risk and guide preventive interventions 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Atherosclerotic Cardiovascular Disease (ASCVD) Risk Factors
The following are some of the key risk factors for ASCVD:
- Hypercholesterolemia 2
- Hypertriglyceridemia 2
- Metabolic syndrome 2
- Chronic kidney disease 2
- Low education 2
- Low income 2
- Unemployment 2
- Diabetes 3, 4
- Heart failure (HF) 4
- Stage 3 or higher chronic kidney disease (CKD) 4
- Familial hypercholesterolemia (FH) 4
- Poorly controlled major risk factors such as hypertension and persistent tobaccoism 4
- Low-density lipoprotein cholesterol 70-189 mg/dL 2
- High-density lipoprotein cholesterol (< 40 mg/dL in men, < 50 mg/dL in women or ≥ 80 mg/dL in men) 5
ASCVD Risk Assessment
ASCVD risk can be assessed using global risk scores based on standard office-based measures 3. The Pooled Cohort Equations (PCEs) are commonly used to estimate ASCVD risk, but they may not accurately estimate risk in certain populations 2. Additional risk-enhancing factors, such as those listed above, can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk 3.
Quantifying ASCVD Risk
The following table quantifies the risk of ASCVD from various risk factors:
| Risk Factor | ASCVD Risk |
|---|---|
| Hypercholesterolemia | Higher ASCVD risk, independent of 10-year risk estimated by the PCEs [2] |
| Hypertriglyceridemia | Higher ASCVD risk, independent of 10-year risk estimated by the PCEs [2] |
| Metabolic syndrome | Higher ASCVD risk, independent of 10-year risk estimated by the PCEs [2] |
| Chronic kidney disease | Higher ASCVD risk, independent of 10-year risk estimated by the PCEs [2] |
| Low education | Higher ASCVD risk [2] |
| Low income | Higher ASCVD risk [2] |
| Unemployment | Higher ASCVD risk [2] |
| Diabetes | 20% or greater 10-year ASCVD risk [4] |
| Heart failure (HF) | 30% or greater 10-year ASCVD risk [4] |
| Stage 3 or higher chronic kidney disease (CKD) | 30% or greater 10-year ASCVD risk [4] |
| Familial hypercholesterolemia (FH) | 30% or greater 10-year ASCVD risk [4] |
| Low-density lipoprotein cholesterol 70-189 mg/dL | Higher ASCVD risk [2] |
| High-density lipoprotein cholesterol (< 40 mg/dL in men, < 50 mg/dL in women or ≥ 80 mg/dL in men) | Higher ASCVD risk, independent of traditional risk factors [5] |
Note: The table is not exhaustive and the risk factors are not mutually exclusive. The ASCVD risk estimates are based on the available evidence and may not be applicable to all individuals.