Emerging and Life Habit Risk Factors

In addition to the five major risks, the ATP III guidelines recognize other factors that contribute to CHD risk. These are classified as life-habit risk factors and emerging risk factors. Life-habit risk factors, consisting of obesity, physical inactivity, and an atherogenic diet, require direct intervention. For example, emerging risk factors are lipopro-tein(a), homocysteine, prothrombotic/proinflammatory factors, lipoprotein-associated phospholipase A2 (Lp-PLA2), and C-reactive protein (CRP). CRP is a marker of low-level inflammation and appears to help in predicting CHD risk beyond LDL choles-

terol and major CHD risk factors. In a recent trial, rosuvastatin significantly reduced the incidence of major cardiovascular events in apparently healthy persons without hy-perlipidemia (LDL cholesterol less than 130 mg/dL [3.37 mmol/L]) but with elevated high-sensitivity CRP levels.14 These results will need to be considered by the ATP IV writing committee.8 In some patients, emerging risk factors may be used to guide the intensity of risk-reduction therapy. Deciding when to consider emerging risk factors requires the use of clinical judgment.

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