Step 3: Risk Factors

The presence of major risk factors other than high LDL may change the goals for treatment. The first step in risk assessment is to count the number of risk factors. If the patient has 2 or more risk factors then the Framingham risk score should be determined (see step 4). The risk score does not need to be determined for persons with 1 or less risk factors.

Major Risk Factors That Modify LDL Goals

Cigarette smoking

Hypertension (BP 140/90 mmHg or on antihypertensive medication)

Low HDL cholesterol (<40 mg/dl)*

Family history of premature CHD (CHD in male first degree relative <55 years; CHD in female first degree relative <65 years)

Age (men 45 years; women 55 years)

*High density lipoprotein (HDL) cholesterol has been shown to have a positive effect on risk of CHD. An HDL level above 60 mg/dL removes one risk factor from the total count. An HDL between 40-60 mg/dl is an optimal range. Lifestyle factors that may increase HDL include exercise, alcohol in moderation, maintenance of a healthy weight, and not smoking. Some drug therapies may also be used to increase HDL in conjunction with drugs used to decrease LDL.