Update on the NCEP ATP-III emerging cardiometabolic risk factors
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Obesity: exploring the causes, consequences and solutions
REVIEW
Open Access
Update on the NCEP ATP-III emerging cardiometabolic risk factors Robert H Eckel* and Marc-Andre Cornier
Abstract The intent of this review is to update the science of emerging cardiometabolic risk factors that were listed in the National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP-III) report of 2001 (updated in 2004). At the time these guidelines were published, the evidence was felt to be insufficient to recommend these risk factors for routine screening of cardiovascular disease risk. However, the panel felt that prudent use of these biomarkers for patients at intermediate risk of a major cardiovascular event over the subsequent 10 years might help identify patients who needed more aggressive low density lipoprotein (LDL) or non-high density lipoprotein (HDL) cholesterol lowering therapy. While a number of other emerging risk factors have been identified, this review will be limited to assessing the data and recommendations for the use of apolipoprotein B, lipoprotein (a), homocysteine, pro-thrombotic factors, inflammatory factors, impaired glucose metabolism, and measures of subclinical atherosclerotic cardiovascular disease for further cardiovascular disease risk stratification. Keywords: Apolipoprotein B, Lipoprotein (a), C-reactive protein, Homocysteine
Introduction It has been long known that certain factors and conditions are associated with increased risk for cardiovascular disease (CVD) and when present warrant more aggressive management. These major risk factors include age, sex, family history, hypertension, diabetes, cholesterol and smoking, with elevated high density lipoprotein (HDL) cholesterol as being protective or a ‘negative’ risk factor. These major risk factors were the basis for the recommendations set forth by the National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP-III) report of 2001 [1] (updated in 2004) [2]. A number of other cardiometabolic risk factors, so called ‘emerging risk factors,’ have also been identified and reviewed [3,4]. These risk factors include, but are not limited to, obesity, metabolic syndrome, hypertriglyceridemia, apolipoprotein B, lipoprotein (a), homocysteine, pro-thrombotic factors, pro-inflammatory factors as well as measures of subclinical atherosclerotic cardiovascular disease (ASCVD). At the time the ATP-III report was published the evidence was felt to be insufficient to recommend these risk factors
for routine screening of CVD. However, the ATP-III panel felt that prudent use of these biomarkers for patients at intermediate risk of a major CVD event over the subsequent 10 years might help identify patients who needed more aggressive low density lipoprotein (LDL) or non-HDL cholesterol lowering therapy. The more recent 2013 American College of Cardiology/ American Heart Association (ACC/AHA) Guideline on the Assessment of Cardiovascular Risk has also made recommendations on the use of some of these emerging risk factors, includi
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