Determining whether or not
you have CAD, or are at risk for CAD, is very important to
your health and is one of the major goals of most physicians.
For most patients, determining your risk for having or developing
CAD starts with a process called risk factor identification
and stratification. With this process, your doctor will review
your history, physical examination, and certain laboratory
values to determine whether or not factors that are known
to predispose to the development of CAD are present and, if
one or more are present, how severe they are. Many of these
risk factors have been described above - your doctor will
assess whether or not these risk factors are operative and
what can be done to decrease your risk for a coronary event
(defined as angina, MI, or a coronary disease-related death).
Some risk factors are modifiable, such as tobacco use, hyperlipidemia,
and hypertension. Other risk factors, such as age, family
history, and gender, are not modifiable.
Once identified and quantified,
CAD risk factors for an individual patient may be integrated
to provide a classification of a patient’s risk for
future coronary events into low-, intermediate-, or high-risk
categories. The intermediate risk category is often subdivided
into moderately high-risk and moderate risk. These risk categories,
as defined by the National Cholesterol Education Program Update
in 2004, are defined as follows:
*CAD: includes history of MI,
unstable angina, stable angina, previous coronary artery procedures,
or clinical evidence of coronary artery disease
**CAD equivalent: non-coronary
atherosclerosis, such as abdominal aortic aneurysm,
carotid arterial disease, stroke, peripheral arterial disease,
diabetes, and 2 or more risk factors
with a 10-year hard risk for CAD of > 20%
*** Major risk factors: cigarette
smoking, hypertension, low HDL cholesterol, family history
of premature CAD (CAD in first-degree relative before the
age of 55 years for men, 65 years for women),
age (men ≥45 years, women ≥55 years)
10-year hard risk for
CAD can be determined using the on-line calculator at: http://www.nhlbi.nih.gov/guidelines/cholesterol.
Treatment aimed at reducing
the risk of CAD is based on the risk assessments provided
above, with defined goals for modifiable risk factors. The
value of this process is that the aggressiveness of treatment
is scaled to the degree of risk. More aggressive therapy may
be more difficult to tolerate, more expensive, and may be
potentially associated with more side effects, and therefore,
knowing the risk provides a solid rationale for pursuing such
therapy. More than half of adult patients in the U.S. are
in the low-risk category, and about 40% are in the intermediate
risk group. How can you determine your risk category? There
are a number of on-line calculators that, with necessary data,
will calculate the cumulative 10-year risk for a coronary
event. These data can be combined with the information above
to determine your CAD risk level.
Risk
Assessment Tool (National Cholesterol Education Program)
Risk
Assessment Tool (American Heart Association)
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