Assessing Cardiac Risk
A crucial part of the initial evaluation is assessing your risk factors for CAD, other than high cholesterol. The major risk factors are as follows:
- Age older than 45 for men and 55 for women
- Post-menopausal status (either natural or surgical) without hormone replacement therapy
- Family history of early atherosclerotic heart disease (early meaning younger than the age of 55 for male relatives or younger than 65 for female relatives)
- High blood pressure
- Diabetes
- Smoking
- Low HDL cholesterol (less than 35 mg/dl)
Establishing a Treatment Goal
Your target cholesterol level depends on several factors. The first is whether or not you already have coronary artery disease. My patient, whom I described earlier, does not have angina or any other symptoms of heart disease, so we are treating her hypercholesterolemia for primary prevention of CAD. Her father has already had a heart attack, so lowering his cholesterol is very important for secondary prevention—i.e., for preventing a subsequent heart attack. Second, your treatment goal depends on your number of CAD risk factors, as detailed below. Unfortunately, diabetes is such a strong risk factor for CAD that it requires the same aggressive treatment as those who have established heart disease.
