Abstract 4029: Systematic Examination of Risk Factor Levels Associated with High and Intermediate 10-Year Risks for Coronary Heart Disease in the ATP-III Risk Assessment Tool
Background: The National Cholesterol Education Program’s ATP-III Risk Assessment Tool, based on the Framingham risk score, predicts absolute 10-year risk for myocardial infarction or coronary death. However, clinicians may be uncertain about and data are sparse regarding the levels of risk factors (RFs) required for predicted risk to exceed the ATP-III threshold values of ≥10% or >20%.
Methods: We entered RF values into the ATP-III Risk Assessment Tool in univariate and multivariate analyses of predicted 10-year risk. We first varied single risk factor levels, holding the other RF levels constant at approximate age-adjusted national means (total cholesterol (chol) 200 mg/dL, HDL-chol 45 mg/dL for men/55 mg/dL for women; systolic BP 130 mm Hg; non-smoking; no BP therapy). We then systematically examined the joint effects of variation in multiple RFs across the spectrum of allowed RF values.
Results: Holding other RF levels constant, women ages 35–75 do not exceed 20% risk with any single elevated RF; and women only exceed 10% risk at ages 70–75 with HDL levels <30 mg/dL or systolic BP>170 mm Hg. In multivariate analyses, women age ≤65 rarely exceed 20% 10-year risk with any combination of RFs; and women ≤65 typically only exceed 10% risk if they are smokers with low HDL levels. For men, the Table⇓ shows single RF levels required to exceed 10% or 20% predicted 10-year risk, with other RFs held constant. All male smokers ≥45 exceed 10% risk. Combinations of only modestly elevated RFs cause many men to exceed 10% risk at ages & ge;45, and to exceed 20% risk at ages ≥55.
Conclusions: These data highlight the risk factor levels required for men and women at different ages to exceed ATP-III risk thresholds used to identify those who may benefit most from CHD preventive therapy. Additional means for risk communication (e.g., lifetime risk estimation) may be needed to help men age <45 and women age <65 understand the importance of addressing multiple moderate or single elevated risk factors.