Identifying & Reducing Risk

How Can I Tell If I Have CAD or If I Am at Risk?

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. Click Here

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)