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. |