High Cholesterol and Risk of Heart Disease

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Hypercholesterolemia refers to increased levels of lipids (or fats) in the blood, which includes cholesterol and triglycerides. High cholesterol does not make you feel bad, but it can significantly increase your risk of developing  heart disease, which is also called coronary heart disease.  High cholesterol can lead to hardened arteries of the heart.  These hardened arteries can be a cause of chest pain or heart attack or both. Because of the risk of this happening, treatment for high cholesterol or high triglycerides is usually recommended. 

One type of cholesterol is LDL cholesterol, known as bad cholesterol, and it is the most accurate predictor of coronary disease, i.e. the higher the number, the more your risk of coronary disease. If you have had a heart attack or another significant vascular event, such as a stroke, your LDL goal should be less than 70. Otherwise anything less than 130 is optimal.

Other risk factors:  Once you are aware of your cholesterol numbers, there are some other factors that also affect ones risk of coronary disease (heart disease).  Other factors that can increase your risk for coronary disease include: cigarette smoking; high blood pressure; family history of heart disease( usually males younger than 55 or females than 65); males; and increasing age.

As well there are certain diseases that increase the risk of complications with coronary disease. Some of these are: Diabetes, type I and 2; symptomatic carotid artery disease—like stroke or TIA; peripheral artery disease; abdominal aortic aneurysm; and kidney disease. 

Do I need treatment? The decision of who gets treatment for cholesterol and at what cholesterol number is treatment recommended is confusing at best for the public. This blog will give the ACP (American College of Physicians) guidelines and a table to determine your own level of risk. The ACP recommendations are based mostly upon the LDL cholesterol and the number of cardiac risk factors as noted above. 

It is important to note that the ACP considers diabetes, carotid disease, aortic aneurysms and peripheral artery disease as heart disease equivalents (in other words equal to heart disease. The others such as smoking, high blood pressure and age are considered major risks, but not equivalents.

If two or more risk factors other than high LDL are present in a patient without heart disease (or an equivalent such as noted above), the ten year risk of developing heart disease is calculated by a risk table( see below).

NOTE:  If you have 0-1 risk factors your 10 year risk is less than 10%. 

Adapted from Adult Treatment Panel III at http://www.nhlbi.nih.gov/ The point total is determined in each category and the 10-year risk determined in the bottom row.

NOTE: These risk estimates for the development of coronary heart disease do not account for all important cardiovascular risk factors. Not included are diabetes mellitus (which is considered a CHD equivalent), family history of CHD, alcohol intake, and the serum C-reactive protein concentration.

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Estimate of 10-Year Risk for Coronary Heart Disease
Framingham Point Scores

Estimate of 10-Year Risk for Men

Framingham Point Scores by Age Group

Age	Points
20-34	-9
35-39	-4
40-44	0
45-49	3
50-54	6
55-59	8
60-64	10
65-69	11
70-74	12
75-79	13

Framingham Point Scores by Age Group and Total Cholesterol

Total Cholesterol	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
<160	0	0	0	0	0
160-199	4	3	2	1	0
200-239	7	5	3	1	0
240-279	9	6	4	2	1
280+	11	8	5	3	1

Framingham Point Scores by Age and Smoking Status

	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
Nonsmoker	0	0	0	0	0
Smoker	8	5	3	1	1

Framingham Point Scores by HDL Level

HDL	Points
60+	-1
50-59	0
40-49	1
<40	2

Framingham Point Scores by Systolic Blood Pressure and Treatment Status

Systolic BP	If Untreated	If Treated
<120	0	0
120-129	0	1
130-139	1	2
140-159	1	2
160+	2	3

10-Year Risk by Total Framingham Point Scores

Point Total	10-Year Risk
< 0	< 1%
0	1%
1	1%
2	1%
3	1%
4	1%
5	2%
6	2%
7	3%
8	4%
9	5%
10	6%
11	8%
12	10%
13	12%
14	16%
15	20%
16	25%
17 or more	30%

Estimate of 10-Year Risk for Women

Framingham Point Scores by Age Group

Age	Points
20-34	-7
35-39	-3
40-44	0
45-49	3
50-54	6
55-59	8
60-64	10
65-69	12
70-74	14
75-79	16

Framingham Point Scores by Age Group and Total Cholesterol

Total Cholesterol	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
<160	0	0	0	0	0
160-199	4	3	2	1	1
200-239	8	6	4	2	1
240-279	11	8	5	3	2
280+	13	10	7	4	2

Framingham Point Scores by Age and Smoking Status

	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
Nonsmoker	0	0	0	0	0
Smoker	9	7	4	2	1

Framingham Point Scores by HDL Level

HDL	Points
60+	-1
50-59	0
40-49	1
<40	2

Framingham Point Scores by Systolic Blood Pressure and Treatment Status

Systolic BP	If Untreated	If Treated
<120	0	0
120-129	1	3
130-139	2	4
140-159	3	5
160+	4	6

10-Year Risk by Total Framingham Point Scores

Point Total	10-Year Risk
< 9	< 1%
9	1%
10	1%
11	1%
12	1%
13	2%
14	2%
15	3%
16	4%
17	5%
18	6%
19	8%
20	11%
21	14%
22	17%
23	22%
24	27%
25 or more	30%

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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