Non-Classical Cardiovascular Disease Risk Factors

Abstract

SIGNIFICANCE OF THE CLINICAL PROBLEM It has been long identified that certain factors and conditions are associated with increased risk for cardiovascular disease (CVD) and when present warrant more aggressive management. These major risk factors include age, sex, family history of CVD, hypertension, diabetes, cholesterol and smoking, and elevated high density lipoprotein cholesterol (HDL-C) as being protective or a “negative” risk factor. These major risk factors were the basis for the recommendations set forth by the National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP-III) report of 2001 (1) (updated in 2004) (2). A number of other cardiometabolic risk factors, so-called “emerging” or “nonclassical” risk factors have also been identified and reviewed (3). These risk factors include but are not limited to obesity, metabolic syndrome, hypertriglyceridemia, apolipoprotein B, lipoprotein (a), homocysteine, prothrombotic factors, proinflammatory factors, as well as measures of subclinical atherosclerotic cardiovascular disease (ASCVD). At the time of the ATP-III report the evidence was felt to be insufficient to recommend these risk factors for routine screening of ASCVD. However, the ATP-III panel felt that prudent use of these biomarkers for patients at intermediate risk of a major CVD event over the next 10 years might help identify patients who needed more aggressive low density lipoprotein cholesterol (LDL-C) or non-HDL cholesterol lowering therapy. The intent of this session is to update the science of specific nonclassical cardiometabolic risk factors that were listed in the NCEP ATP-III report. Although other risk factors have been identified, this session will be limited to assessing the data and recommendations for the use of apolipoprotein B, lipoprotein (a), impaired glucose metabolism, and measures of subclinical ASCVD for further CVD risk stratification that may be helpful in clinical decision making.