Dyslipidemias pp 313-327 | Cite as

Perspectives on Cholesterol Guidelines

  • Scott M. GrundyEmail author
Part of the Contemporary Endocrinology book series (COE)


Since the 1980s, cholesterol guidelines for Americans have been sponsored by The National Heart, Lung, and Blood Institute of the National Institutes of Health. These guidelines were produced by the National Cholesterol Education Program. From this program, an Adult Treatment Panel (ATP) has organized the major sets of guidelines. Three reports were issued by ATP. The third and last was updated by a smaller panel in 2004. More recently, the National Heart, Lung, and Blood Institute has turned the cholesterol guideline process over to the American College of Cardiology and the American Heart Association (ACC/AHA). Guidelines from other countries have generally followed the third ATP report. ACC/AHA guidelines have attempted to restrict their recommendations to information derived from randomized clinical trials. Thus, they are much narrower than ATP reports. The latter made recommendations on several lines of evidence, including clinical trials, epidemiology, genetics, and dietary and metabolic studies. Since the publication of ACC/AHA recommendations, considerable controversy has emerged on how best to develop cholesterol guidelines. This chapter examines this question and suggests potential approaches.


Cholesterol Guidelines Risk assessment Lipoproteins Statins Secondary prevention Primary prevention 


  1. 1.
    National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation. and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106:3143–421.Google Scholar
  2. 2.
    Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al. National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110(2):227–39. (Review. Erratum. Circulation. 2004 Aug;110(6):763).PubMedCrossRefGoogle Scholar
  3. 3.
    Cohen JC, Boerwinkle E, Mosley TH Jr, Hobbs HH. Sequence variations in PCSK9, low LDL, and protection against coronary heart disease. N Engl J Med. 2006;354(12):1264–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.Google Scholar
  5. 5.
    Rossouw JE, Lewis B, Rifkind BM. The value of lowering cholesterol after myocardial infarction. N Engl J Med. 1990;323(16):1112–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–89.Google Scholar
  7. 7.
    Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335(14):1001–09.PubMedCrossRefGoogle Scholar
  8. 8.
    Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med. 1997;336(3):153–62.CrossRefGoogle Scholar
  9. 9.
    Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339(19):1349–57.CrossRefGoogle Scholar
  10. 10.
    Serruys PW, de Feyter P, Macaya C, Kokott N, Puel J, Vrolix M, et al. Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002;287(24):3215–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. The Lancet. 2002;360(9326):7–22.CrossRefGoogle Scholar
  12. 12.
    Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. The Lancet. 2002;360(9346):1623–30.CrossRefGoogle Scholar
  13. 13.
    Holdaas H, Fellstrom B, Jardine AG, Holme I, Nyberg G, Fauchald P, et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, ranomised, placebo-controlled trial. The Lancet. 2003;361(9374):2024–31.CrossRefGoogle Scholar
  14. 14.
    Athyros VG, Papageorgiou AA, Mercouris BR, Athyrou VV, Symeonidis AN, et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus ‘usual’ care in secondary coronary heart disease prevention. Curr Med Res Opin. 2002;18(4):220–28.PubMedCrossRefGoogle Scholar
  15. 15.
    Cannon CP, Braunwald E, McCabe CH, et al. Comparison of intensive and moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495–504.PubMedCrossRefGoogle Scholar
  16. 16.
    Nissen SE, Tuzcu EM, Schoenhagen P, Brown BG, Ganz P, Vogen RA, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA. 2004;291(9):1071–80.PubMedCrossRefGoogle Scholar
  17. 17.
    LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352(14):1425–35.PubMedCrossRefGoogle Scholar
  18. 18.
    SEARCH investigators. Study of the effectiveness of additional reductions in cholesterol and homocysteine. Accessed: 18. Sept. 2005.
  19. 19.
    Pedersen TR, Faergeman O, Holme I, Olsson AG, Tikkanen MJ. Effect of greater LDL-C reductions on prognosis: the Incremental Decrease in Endpoints through Aggressive Lipid Lowering (IDEAL) trial. Atherosclerosis. 1999;144:38.CrossRefGoogle Scholar
  20. 20.
    Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study—a randomized controlled trial. JAMA. 2001;285(13):1711–18.PubMedCrossRefGoogle Scholar
  21. 21.
    Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. The Lancet. 2003;361(9374):2005–16.CrossRefGoogle Scholar
  22. 22.
    Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. World Heart Federation and the Preventive Cardiovascular Nurses Association. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458–73. (Epub 2011 Nov 3).PubMedCrossRefGoogle Scholar
  23. 23.
    Catapano AL, Reiner Z, De Backer G, Graham I, Taskinen MR, Wiklund O, et al. European Society of Cardiology (ESC); European Atherosclerosis Society (EAS). ESC/EAS guidelines for the management of dyslipidaemias the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. 2011;217(1):3–46.PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson TJ, Grégoire J, Hegele RA, Couture P, Mancini GB, McPherson R, et al. 2012 update of the Canadian cardiovascular society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29(2):151–67.PubMedCrossRefGoogle Scholar
  25. 25.
    Boekholdt SM, Arsenault BJ, Mora S, Pedersen TR, LaRosa JC, Nestel PJ, et al. Association of LDL cholesterol, non–HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins. JAMA. 2012;307(12):1302–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Boekholdt SM, Hovingh GK, Mora S, Arsenault BJ, Amarenco P, Pedersen TR, et al. Very low levels of atherogenic lipoproteins and risk of cardiovascular events; a meta-analysis of statin trials. In press JACC 2014.Google Scholar
  27. 27.
    Varbo A, Benn M, Tybjærg-Hansen A, Jørgensen AB, Frikke-Schmidt R, Nordestgaard BG. Remnant cholesterol as a causal risk factor for ischemic heart disease. J Am Coll Cardiol. 2013;61(4):427–36.PubMedCrossRefGoogle Scholar
  28. 28.
    Barter PJ, Ballantyne CM, Carmena R, Castro Cabezas M, Chapman MJ, Couture P, et al. Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel. J Intern Med. 2006;259(3):247–58.PubMedCrossRefGoogle Scholar
  29. 29.
    Sniderman AD, Islam S, Yusuf S, McQueen MJ. Discordance analysis of apolipoprotein B and non-high density lipoprotein cholesterol as markers of cardiovascular risk in the INTERHEART study. Atherosclerosis. 2012;225(2):444–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Mora S, Glynn RJ, Boekholdt S, Nordestgaard BG, Kastelein JP, Ridker PM. On-treatment non–high-density lipoprotein cholesterol, apolipoprotein B, triglycerides, and lipid ratios in relation to residual vascular risk after treatment with potent statin therapy: JUPITER (Justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin). J Am Coll Cardiol. 2012;59(17):1521–8.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Brunzell JD, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, et al. American Diabetes Association; American College of Cardiology Foundation. Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care. 2008;31(15):811–22.PubMedCrossRefGoogle Scholar
  32. 32.
    Kastelein JJ, van der Steeg WA, Holme I, Gaffney M, Cater NB, Barter P, et al. TNT Study Group; IDEAL Study Group. Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment. Circulation. 2008;117(23):3002–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Clarenbach JJ, Grundy SM, Palacio N, Vega GL. Relationship of apolipoprotein B levels to the number of risk factors for metabolic syndrome. J Investig Med. 2007;55(5):237–47.PubMedCrossRefGoogle Scholar
  34. 34.
    Grundy SM, Vega GL, Tomassini JE, Tershakovec AM. Comparisons of apolipoprotein B levels estimated by immunoassay, nuclear magnetic resonance, vertical auto profile, and non-high-density lipoprotein cholesterol in subjects with hypertriglyceridemia (SAFARI Trial). Am J Cardiol. 2011;108(1):40–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Harper CR, Jacobson TA. Using apolipoprotein B to manage dyslipidemic patients: time for a change? Mayo Clin Proc. 2010;85(5):440–5.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Ray KK, Cannon CP, Cairns R, Morrow DA, Ridker PM, Braunwald E. Prognostic utility of apoB/AI, total cholesterol/HDL, non-HDL cholesterol, or hs-CRP as predictors of clinical risk in patients receiving statin therapy after acutecoronary syndromes: results from PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol. 2009;29(3):424–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Lipid Research Clinics Program. The lipid research clinics coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease. JAMA. 1984;251:351–64.CrossRefGoogle Scholar
  38. 38.
    Bays HE, Moore PB, Drehobl MA, Rosenblatt S, Toth PD, Dujovne CA, et al. Ezetimibe Study Group. Effectiveness and tolerability of ezetimibe in patients with primary hypercholesterolemia: pooled analysis of two phase II studies. ClinTher. 2001;23(8):1209–30. (Erratum in: ClinTher 2001 Sep;23(9):1601).Google Scholar
  39. 39.
    Hunninghake D, Insull W Jr, Toth P, Davidson D, Donovan JM, Burke SK. Coadministration of colesevelam hydrochloride with atorvastatin lowers LDL cholesterol additively. Atherosclerosis. 2001;158(2):407–16.PubMedCrossRefGoogle Scholar
  40. 40.
    Leiter LA, Bays H, Conard S, Bird S, Rubino J, Hanson ME, et al. Efficacy and safety of ezetimibe added on to atorvastatin (40 mg) compared with uptitration of atorvastatin (to 80 mg) in hypercholesterolemic patients at high risk of coronary heart disease. Am J Cardiol. 2008;102(11):1495–501. (Epub 2008 Oct 23).PubMedCrossRefGoogle Scholar
  41. 41.
    Califf RM, Lokhnygina Y, Cannon CP, Stepanavage ME, McCabe CH, Musliner TA, et al. An update on the IMProved reduction of outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) design. Am Heart J. 2010;159(5):705–9. (Epub 2010 Mar 15).PubMedCrossRefGoogle Scholar
  42. 42.
    Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, et al. Fifteen year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986;8(6):1245–55.PubMedCrossRefGoogle Scholar
  43. 43.
    Canner PL, Furberg CD, Terrin ML, McGovern ME, et al. Benefits of niacin by glycemic status in patients with healed myocardial infarction (from the Coronary Drug Project). Am J Cardiol. 2005;95(2):254–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Brown BG, Zhao XQ. Nicotinic acid, alone and in combinations, for reduction of cardiovascular risk. Am J Cardiol. 2008;101(8A):58B–62B.PubMedCrossRefGoogle Scholar
  45. 45.
    Taylor AJ, Lee HJ, Sullenberger LE. The effect of 24 months of combination statin and extended-release niacin on carotid intima-media thickness: ARBITER 3. Curr Med Res Opin. 2006;22(11):2243–50.PubMedCrossRefGoogle Scholar
  46. 46.
    AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365(24):2255–67.PubMedCrossRefGoogle Scholar
  47. 47.
    Cuchel M, Bloedon LT, Szapary PO, Kolansky DM, Wolfe ML, Sarkis A, et al. Inhibition of microsomal triglyceride transfer protein in familial hypercholesterolemia. N Engl J Med. 2007;356(2):148–56.PubMedCrossRefGoogle Scholar
  48. 48.
    Stein EA, Dufour R, Gagne C, Gaudet D, East C, Donovan JM, et al. Apolipoprotein B synthesis inhibition with mipomersen in heterozygous familial hypercholesterolemia: results of a randomized, double-blind, placebo-controlled trial to assess efficacy and safety as add-on therapy in patients with coronary artery disease. Circulation. 2012;126(19):2283–92. (Epub 2012 Oct 11).PubMedCrossRefGoogle Scholar
  49. 49.
    Barter PJ, Caulfield M, Eriksson M, Grundy SM, Kastelein JJ, Komajda M, et al. ILLUMINATE Investigators. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med. 2007;357(21):2109–22. (Epub 2007 Nov 5.)PubMedCrossRefGoogle Scholar
  50. 50.
    Schwartz GG, Olsson AG, Abt M, Ballantyne CM, Barter PJ, Brumm J, et al. dal-OUTCOMES Investigators. Effects of dalcetrapib in patients with a recent acute coronary syndrome. N Engl J Med. 2012;367(22):2089–99. (Epub 2012 Nov 5).PubMedCrossRefGoogle Scholar
  51. 51.
    Cannon CP, Shah S, Dansky HM, Davidson M, Brinton EA, Gotto AM, et al. Determining the Efficacy and Tolerability Investigators. Safety of anacetrapib in patients with or at high risk for coronary heart disease. N Engl J Med 2010;363(25):2406–15. (Epub 2010 Nov 17).PubMedCrossRefGoogle Scholar
  52. 52.
    Horton JD, Cohen JC, Hobbs HH. PCSK9: a convertase that coordinates LDL catabolism. J Lipid Res. 2009;50 Suppl:S172–7. Epub 2008 Nov 19.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Lo Surdo PB, Pandit S, et al. Mechanistic implications for LDL receptor degradation from the PCSK9/ LDLR structure at neutral pH. EMBO Rep. 2011;12(12):1300–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Cohen JC. Emerging LDL therapies: using human genetics to discover new therapeutic targets for plasma lipids. J Clin Lipidol. 2013;7(3 Suppl):S1–5. (Epub 2013 Mar 26).PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Benn M, Nordestgaard BG, Grande P, Schnohr P, Tybjaerg-Hansen A. PCSK9 R46L, low-density lipoprotein cholesterol levels, and risk of ischemic heart disease: 3 independent studies and meta-analyses. J Am Coll Cardiol. 2010;55(25):2833–42. Review.PubMedCrossRefGoogle Scholar
  56. 56.
    Stein EA, Gipe D, Bergeron J, Gaudet D, Weiss R, Dufour R, et al. Effect of a monoclonal antibody to PCSK9, REGN727/SAR236553, to reduce low-density lipoprotein cholesterol in patients with heterozygous familial hypercholesterolaemia on stable statin dose with or without ezetimibe therapy: a phase 2 randomised controlled trial. Lancet. 2012;380(9836):29–36. (Epub 2012 May 26).PubMedCrossRefGoogle Scholar
  57. 57.
    Roth EM, McKenney JM, Hanotin C, Asset G, Stein EA. Atorvastatin with or without an antibody to PCSK9 in primary hypercholesterolemia. N Engl J Med. 2012;367(20):1891–900. (Epub 2012 Oct 31).PubMedCrossRefGoogle Scholar
  58. 58.
    Grundy SM, Vega GL. Fibric acids: effects on lipids and lipoprotein metabolism. Am J Med. 1987;83(5B):9–20.PubMedCrossRefGoogle Scholar
  59. 59.
    Jun M, Foote C, Lv J, Neal B, Patel A, Nicholls SJ, et al. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. The Lancet. 2010;375(9729):1875–84.CrossRefGoogle Scholar
  60. 60.
    Lee M, Saver JL, Towfighi A, Chow J, Ovbiagete B. Efficacy of fibrates for cardiovascular risk reduction in persons with atherogenic dyslipidemia: a meta-analysis. Atherosclerosis. 2011;217(2):492–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Guo J, Meng F, Ma N, Li C, Ding Z, Wang H, et al. Meta-analysis of safety of the coadministration of statin with fenofibrate in patients with combined hyperlipidemia. Am J Cardiol. 2012;110(9):1296–301. (Epub 2012 Jul 27).PubMedCrossRefGoogle Scholar
  62. 62.
    D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM. General cardiovascular risk profile for use in primary care. The Framingham heart study. Circulation. 2008;117(6):743–53.PubMedCrossRefGoogle Scholar
  63. 63.
    Tattersall MC, Karmali KN, Gangnon RE, Keevil JG. The population effects of the global cardiovascular risk model in United States adults: findings from the National Health and Nutrition Surveys, 2005–2006. J Clin Lipidol. 2011;5(3):166–72. (Epub 2011 Mar 2).PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA Guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2013 [Epub ahead of print).Google Scholar
  65. 65.
    Ridker PM, Cook NR. Statins: new American guidelines for prevention of cardiovascular disease. The Lancet. 2013;382(9907):1762–5.CrossRefGoogle Scholar
  66. 66.
    Eichler K, Puhan MA, Steurer J, Bachmann LM. Prediction of first coronary events with the Framingham score: a systematic review. Am Heart J. 2007;153(5):722–31.PubMedCrossRefGoogle Scholar
  67. 67.
    Marrugat J, D’Agostino R, Sullivan L, Elosua R, Wilson P, Ordovas J, et al. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health. 2003;57(8):634–8.PubMedCentralPubMedCrossRefGoogle Scholar
  68. 68.
    Marques-Vidal P, Rodondi N, Bochud M, Pecoud A, Hayoz D, Paccaud F, et al. Predictive accuracy of original and recalibrated Framingham risk score in the Swiss population. Int J Cardiol. 2009;133(4):346–53.PubMedCrossRefGoogle Scholar
  69. 69.
    Brindle P, Emberson J, Lampe F, Walker M, Whincup P, Fahey T, et al. Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study. BMJ. 2003;327(7426):1267.PubMedCentralPubMedCrossRefGoogle Scholar
  70. 70.
    Menotti A, Puddu PE, Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. 2000;21(5):365–70.PubMedCrossRefGoogle Scholar
  71. 71.
    Laurier D, Nguyen PC, Cazelles B, Segond P. Estimation of CHD risk in a French working population using a modified Framingham model. The PCV-METRA Group. J Clin Epidemiol. 1994;471(12):1353–64.CrossRefGoogle Scholar
  72. 72.
    Hense HW, Schulte H, Lowel H, Assman G, Keil U. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany—results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J. 2003;24(10):937–45.PubMedCrossRefGoogle Scholar
  73. 73.
    Lloyd-Jones DM, Wilson PW, Larson MG, Beiser A, Leip EP, D’Agostino RB, et al. Framingham risk score and prediction of lifetime risk for coronary heart disease. Am J Cardiol. 2004;94(1):20–4.PubMedCrossRefGoogle Scholar
  74. 74.
    Pencina MJ, D’Agostino RB, Beiser AS, Cobain MR, Vasan RS. Estimating lifetime risk of developing high serum total cholesterol: adjustment for baseline prevalence and single-occasion measurements. Am J Epidemiol. 2007;165(4):464–72. (Epub 2006 Nov 20).PubMedCrossRefGoogle Scholar
  75. 75.
    Pencina MJ, D’Agostino RB Sr, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study. Circulation. 2009;119(24):3078–84. Epub 2009.PubMedCentralPubMedCrossRefGoogle Scholar
  76. 76.
    Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366(4):321–9.PubMedCentralPubMedCrossRefGoogle Scholar
  77. 77.
    Hippisley-Cox J, Coupland C, Robson J, Brindle P. Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using Q Research database. BMJ. 2010;341:c6624.PubMedCentralPubMedCrossRefGoogle Scholar
  78. 78.
    Lloyd-Jones DM, Larson MG, Beiser A, Levy D. Lifetime risk of developing coronary heart disease. The Lancet. 1999;353(16):89–92.CrossRefGoogle Scholar
  79. 79.
    Lloyd-Jones DM, Wilson PW, Larson MG, Leip E, Beiser A, D’Agostino RB, et al. Lifetime risk of coronary heart disease by cholesterol levels at selected ages. Arch Intern Med. 2003;163(16):1966–72.PubMedCrossRefGoogle Scholar
  80. 80.
    Lloyd-Jones DM, Leip EP, Larson MG, D’Agostino RB, Beiser A, Wilson PW, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation. 2006;113(6):791–8. (Epub 2006 Feb 6).PubMedCrossRefGoogle Scholar
  81. 81.
    Lloyd-Jones DM, Dyer AR, Wang R, Daviglus ML, Greenland P. Risk factor burden in middle age and lifetime risks for cardiovascular and non-cardiovascular death (Chicago Heart Association Detection Project in Industry). Am J Cardiol. 2007;99(4):535–40.PubMedCentralPubMedCrossRefGoogle Scholar
  82. 82.
    Marma AK, Berry JD, Ning H, Persell SD, Lloyd-Jones DM. Distribution of10-year and lifetime predicted risks for cardiovascular disease in US adults: findings from the National Health and Nutrition Examination Survey 2003–2006. Circ Cardiovasc Qual Outcomes. 2010;3(1):8–14.PubMedCentralPubMedCrossRefGoogle Scholar
  83. 83.
    Allen N, Berry JD, Ning H, Van Horn L, Dyer A, Lloyd-Jones DM. Impact of blood pressure and blood pressure change during middle age on the remaining lifetime risk for cardiovascular disease: the cardiovascular lifetime risk pooling project. Circulation. 2012;125(1):37–44.PubMedCentralPubMedCrossRefGoogle Scholar
  84. 84.
    Wilkins JT, Ning H, Berry J, Zhao L, Dyer AR, Lloyd-Jones DM. Lifetime risk and years lived free of total cardiovascular disease. JAMA. 2012;308(17):1795–801.PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    Karmali KN, Lloyd-Jones DM. Adding a life-course perspective to cardiovascular-risk communication. Nat Rev Cardiol. 2013;10(2):111–5. (Epub 2013 Jan 8).PubMedCrossRefGoogle Scholar
  86. 86.
    Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, Brindle P. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ. 2008;336(7659):1475–82. (Epub 2008 Jun 23).PubMedCentralPubMedCrossRefGoogle Scholar
  87. 87.
    Collins GS, Altman DG. Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK2. BMJ. 2012;344:e4181.PubMedCentralPubMedCrossRefGoogle Scholar
  88. 88.
    Expert Dyslipidemia Panel of the International Atherosclerosis Society Panel members. An international atherosclerosis society position paper: global recommendations for the management of dyslipidemia–full report. J Clin Lipidol. 2014;8(1):29–60.CrossRefGoogle Scholar
  89. 89.
    Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM, et al. American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/ AHA Writing Committee to Update the 2000 expert consensus document on electron beam computed tomography); society of atherosclerosis imaging and prevention; society of cardiovascular computer tomography. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation. 2007;115(3):402–26. (Epub 2007 Jan 12).PubMedCrossRefGoogle Scholar
  90. 90.
    Rumberger JA, Schwartz RS, Simons DB, Sheedy PF III, Edwards WD, Fitzpatrick LA. Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy. Am J Cardiol. 1994;73(16):1169–73.PubMedCrossRefGoogle Scholar
  91. 91.
    Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation. 1995;92(8):2157–62.PubMedCrossRefGoogle Scholar
  92. 92.
    Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. Circulation. 1996;93(5):898–904.PubMedCrossRefGoogle Scholar
  93. 93.
    Guerci AD, Spadaro LA, Popma JJ, Goodman KJ, Brundage BH, Budoff M, et al. Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and symptomatic adults. Am J Cardiol. 1997;79(2):128–33.PubMedCrossRefGoogle Scholar
  94. 94.
    Schmermund A, Baumgart D, Gorge G, Gronemeyer D, Seibel R, Bailey KR, Rumberger JA, Paar D, Erbel R. Measuring the effect of risk factors on coronary atherosclerosis: coronary calcium score versus angiographic disease severity. J Am Coll Cardiol. 1998;31(6):1267–73.PubMedCrossRefGoogle Scholar
  95. 95.
    Grundy SM. Age as a risk factor: you are as old as your arteries. Am J Cardiol. 1999;83(10):1455–7.PubMedCrossRefGoogle Scholar
  96. 96.
    McClelland RL, Nasir K, Budoff M, Blumenthal RS, Kronmal RA. Arterial age as a function of coronary artery calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol. 2009;103(1):59–63.PubMedCentralPubMedCrossRefGoogle Scholar
  97. 97.
    O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular health study collaborative research group. N Engl J Med. 1999;340(1):14–22.PubMedCrossRefGoogle Scholar
  98. 98.
    Lowe GD, Danesh J. The need for risk factor assessment in atherothrombotic vascular disease. Semin Vasc Med. 2002;2(3):231–2.PubMedCrossRefGoogle Scholar
  99. 99.
    Ridker PM, Paynter NP, Rifai N, Gaziano JM, Cook NR. C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation. 2008;118(22):2243–51.PubMedCentralPubMedCrossRefGoogle Scholar
  100. 100.
    Cook NR, Paynter NP, Eaton CB, Manson JE, Martin LW, Robinson JG, et al. Comparison of the Framingham and Reynolds Risk scores for global cardiovascular risk prediction in the multiethnic Women’s Health Initiative. Circulation. 2012;125(14):1748–56.PubMedCentralPubMedCrossRefGoogle Scholar
  101. 101.
    Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, Montori VM. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49(4):403–14.PubMedCrossRefGoogle Scholar
  102. 102.
    Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32.PubMedCrossRefGoogle Scholar
  103. 103.
    Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, et al. JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195–207.PubMedCrossRefGoogle Scholar
  104. 104.
    Ginsberg HN. The 2013 ACC/AHA guidelines on the treatment of blood cholesterol. Questions, questions, questions. Circ Res. 2014;114(5):761–4.PubMedCrossRefGoogle Scholar
  105. 105.
    Anderson TJ, Grégoire J, Hegele RA, Couture P, Mancini GB, McPherson R, et al. Are the ACC/AHA Guidelines on the treatment of blood cholesterol a game changer? A perspective from the canadian cardiovascular society dyslipidemia panel. Can J Cardiol. 2014;30(4):37–80.CrossRefGoogle Scholar
  106. 106.
    Raymond C, Cho L, Rocco M, Hazen SL. New cholesterol guidelines: worth the wait? Cleve Clin J Med. 2014;81(1):11–9.PubMedCentralPubMedCrossRefGoogle Scholar
  107. 107.
    Breslow JL. Perspective on the 2013 American Heart Association/American College of Cardiology Guideline for the use of statins in primary prevention of low-risk individuals. Circ Res. 2014;114(5):758–60.PubMedCentralPubMedCrossRefGoogle Scholar
  108. 108.
    The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA. 1984;251(13):351–64.Google Scholar
  109. 109.
    The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA. 1984;251(3):365–74.CrossRefGoogle Scholar
  110. 110.
    Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, et al. Fifteen year mortality in Coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986;8(6):1245–55.PubMedCrossRefGoogle Scholar
  111. 111.
    Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, Huttunen JK, Kaitaniemi P, Koskinen P, Manninen V, et al. Helsinki heart study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987;317(20):1237–45.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press 2015

Authors and Affiliations

  1. 1.Center for Human NutritionDepartment of Internal MedicineDallasUSA

Personalised recommendations