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Table 1 European, Canadian and ACC/AHA guidelines on the use of emerging risk factors

From: Update on the NCEP ATP-III emerging cardiometabolic risk factors

Emerging risk factor European[6] Canadian[7] ACC/AHA[5]
Apo B No added value; may be a more accurate assessment of CVD risk versus LDL-C in patients with hypertriglyceridemia ≥120 mg/dL as an alternative marker for intermediate risk patients with LDL-C <3.5 mmol/L Screening not recommended
Lipoprotein (a) Screening not recommended Consider for intermediate risk patients. Levels >30 mg/dL considered higher CVD risk Screening not recommended
Homocysteine May be used in persons at moderate CVD risk. Screening not recommended Screening not recommended
Pro-thrombotic factors Fibrinogen may be used in persons at moderate CVD risk. Screening not recommended Screening not recommended
Pro-inflammatory factors hsCRP may be used in persons at moderate CVD risk. Screening not recommended Consider screening with hsCRP for intermediate risk patients and consider statin therapy for patients with levels ≥2 mg/dL.
Impaired fasting glucose Screening not recommended Recommended for all for risk stratification and diagnosis of diabetes Screening not recommended
Subclinical atherosclerosis Consider statin therapy for asymptomatic patients at moderate risk with carotid plaque ≥0.5 mm of IMT or IMT ≥1.5 mm. Recommendations based on CCS are vague but a high CCS is a high CVD risk and a statin should be prescribed. For intermediate risk patients consider statin therapy for patients with carotid plaque or CIMT >75th %tile for age and gender; and for a CCS >100 Agatston units. Consider statin therapy for patients with a calculated 10 year CVD risk between 5.0% to 7.5% or even <5.0% with a CCS ≥300 Agatston units or ≥75th %tile for age, gender and ethnicity.
  1. ACC/AHA, American College of Cardiology/American Heart Association; Apo-B, apolipoprotein B; CCS,; CIMT, carotid intima-media thickness; CVD, cardiovascular disease; hsCRP, high sensitivity C-reactive protein; IMT, intima media thickness; LDL-C, low density lipoprotein cholesterol.