| Risk-enhancing factors |
- Family history of premature ASCVD (males, age <55 years; females, age <65 years)
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- Primary hypercholesterolemia (LDL cholesterol, 160 to 189 mg/dL [4.1 to 4.8 mmol/L]; non-HDL cholesterol 190 to 219 mg/dL [4.9 to 5.6 mmol/L])*
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- Metabolic syndrome (increased waist circumference [by ethnically appropriate cutpoints], elevated triglycerides [>150 mg/dL, nonfasting], elevated blood pressure, elevated glucose, and low HDL cholesterol [<40 mg/dL in males; <50 mg/dL in females] are factors; a tally of 3 makes the diagnosis)
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- Chronic kidney disease (eGFR 15 to 59 mL/min/1.73 m2 with or without albuminuria; not treated with dialysis or kidney transplantation)
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- Chronic inflammatory conditions, such as psoriasis, RA, lupus, or HIV/AIDS
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- History of premature menopause (before age 40 years) and history of pregnancy-associated conditions that increase later ASCVD risk, such as preeclampsia
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- High-risk race/ethnicity (eg, South Asian ancestry)
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- Lipids/biomarkers associated with increased ASCVD risk
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- Persistently elevated* primary hypertriglyceridemia (≥175 mg/dL, nonfasting)
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- Elevated high-sensitivity C-reactive protein (≥2.0 mg/L).
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- Elevated Lp(a): A relative indication for its measurement is family history of premature ASCVD. An Lp(a) ≥50 mg/dL or ≥125 nmol/L constitutes a risk-enhancing factor, especially at higher levels of Lp(a).
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- Elevated apoB (≥130 mg/dL): A relative indication for its measurement would be triglyceride ≥200 mg/dL. A level ≥130 mg/dL corresponds to an LDL cholesterol >160 mg/dL and constitutes a risk-enhancing factor.
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