Risk enhancers

Family history of premature atherosclerotic cardiovascular disease (in men age < 55 or in women age < 65)
Primary hypercholesterolemia
 Low-density lipoprotein cholesterol 160–180 mg/dL
 Non-high-density lipoprotein cholesterol 190–219 mg/dL
Metabolic syndrome: 3 or more of the following:
 Increased waist circumference by ethnically appropriate cut points
 Fasting triglyceride level > 150 mg/dL
 High blood pressure
 Elevated glucose
 Low high-density lipoprotein cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
 Chronic kidney disease (estimated glomerular filtration rate 15–59 mL/min/1.73 m2)
Chronic inflammatory conditions (eg, psoriasis, rheumatoid arthritis, lupus, human immunodeficiency virus infection, acquired immunodeficiency syndrome)
History of premature menopause (age < 40) and history of pregnancy-associated conditions that increase later risk of atherosclerotic cardiovascular disease such as preeclampsia
High-risk ethnicity or race (eg, South Asian)
Lipids or biomarkers associated with elevated risk
 Persistently elevated hypertriglyceridemia (≥ 175 mg/dL nonfasting)
 Elevated high-sensitivity C-reactive protein (≥ 2.0 mg/L)
 Elevated lipoprotein (a) (≥ 50 mg/dL or ≥ 125 nmol/L) (relative indication for measurement: family history of premature atherosclerotic cardiovascular disease)
 Elevated apolipoprotein B (≥ 130 mg/dL) (relative indication for measurement: triglycerides ≥ 200 mg/dL)
 Ankle-brachial index < 0.9
  • Reprinted from Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73(24):3168–3209. doi:10.1016/j.jacc.2018.11.002, with permission from Elsevier.