GRUNDY
ET AL., Assessment of Cardiovascular Risk
J Am Coll Cardiol 1999;34:1348--59
AHA/ACC
Scientific Statement: Assessment of Cardiovascular Risk
by Use of Multiple-Risk-Factor Assessment Equations
A
Statement for Healthcare Professionals From the American
Heart Association and the American College of Cardiology
I.
Preamble and Introduction
The
past decade has witnessed major strides in the prevention
of coronary heart disease (CHD) through modification of
its causes. The most dramatic advance has been the demonstration
that aggressive medical therapy will substantially reduce
the likelihood of recurrent major coronary syndromes in
patients with established CHD (secondary prevention).
The American Heart Association (AHA) and the American
College of Cardiology (ACC) have published joint recommendations
for medical intervention in patients with CHD and other
forms of atherosclerotic disease 1.
A similar potential exists for risk reduction in patients
without established CHD (primary prevention). However,
the risk status of persons without CHD varies greatly,
and this variability mandates a range in the intensity
of interventions. Effective primary prevention thus requires
an assessment of risk to categorize patients for selection
of appropriate interventions. The present statement is
being published jointly by the AHA and ACC to outline
current issues and approaches to global risk assessment
for primary prevention. The approaches described in this
statement can be used for guidance at several levels of
primary prevention; however, the statement does not attempt
to specifically link risk assessment to treatment guidelines
for particular risk factors. Nonetheless, it provides
critical background information that can be used in the
development of new treatment guidelines.
The major and independent risk factors for CHD are cigarette
smoking of any amount, elevated blood pressure, elevated
serum total cholesterol and low-density lipoprotein
cholesterol (LDL-C), low serum high-density lipoprotein
cholesterol (HDL-C), diabetes mellitus, and advancing
age (Table 1). The quantitative
relationship between these risk factors and CHD risk
has been elucidated by the Framingham Heart Study 2
and other studies. These studies 2
show that the major risk factors are additive in predictive
power. Accordingly, the total risk of a person can be
estimated by a summing of the risk imparted by each
of the major risk factors. Other factors are associated
with increased risk for CHD (Table
2). These are of 2 types: conditional risk factors
and predisposing risk factors. The conditional risk
factors are associated with increased risk for CHD,
although their causative, independent, and quantitative
contributions to CHD have not been well documented.
The predisposing risk factors are those that worsen
the independent risk factors. Two of them—obesity
and physical inactivity—are designated major risk
factors by the AHA 3,4.
The adverse effects of obesity are worsened when it
is expressed as abdominal obesity 5,
an indicator of insulin resistance.
Copyright
© 2000 by The American Heart Association, Inc.
and
The American College of Cardiology
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