Nontraditional Cardiovascular Risk Factors

We have several risk models to try to assess which patients are at highest risk for heart disease. The traditional models use the widely accepted parameters such as cholesterol levels, smoking, diabetes, hypertension, and family history. Much of the collected data stems from the Framingham model. (Quick calculation)

In order to further refine risk assessment, the AHRQ (Agency for Health Care Research and Quality) has evaluated some non-traditional risk factors and issued recommendations. These recommendations are aimed at asymptomatic adults with an intermediate risk (10-20%) of future heart disease as determined by multiple traditional risk factors (such as the Framingham or ATPIII models).

There is agreement that measurement of cardiac C-reactive protein (CRP) may be reasonable in persons who have an intermediate risk and it is uncertain as to the use of preventive therapies such as starting cholesterol-lowering medications.

There is also agreement that lipid studies beyond the standard fasting profile are not recommended. The non-recommended screening tests include lipoprotein subclasses, apolipoproteins, particle size and density. However, these tests might be helpful in identifying susceptible individuals where there is a strong family history.  An emerging test, lipoprotein-associated phospholipase A2 (Lp-PLA2) might be helpful; data is still pending.

There is no evidence that homocysteine level screening is helpful. Measurement of natriuretic peptide is not recommended in asymptomatic adults. Fibrinogen and white blood cells are independent markers of cardiovascular risk, but there is insufficient evidence for the use in screening.

For the full AHRQ report.