The Framingham algorithm, which helps clinicians calculate cholesterol targets for people with different cardiac risk factors, may be inadequate for determining a person’s risk of coronary artery disease (CAD).
Jean-Pierre Després and coauthors have reviewed how individuals with a normal low-density lipoprotein (LDL) cholesterol level can still be at increased risk of CAD, particularly if they carry additional risk factors such as central obesity, elevated serum triglyceride levels and insulin resistance. In such people, a better marker for increased CAD risk may be an elevated total cholesterol:high-density lipoprotein cholesterol ratio. Thus, even if such a person’s LDL cholesterol level is considered acceptable, the authors recommend targeting the causal factors of this atherogenic dyslipidemia, including abdominal obesity.
p. 1331 Evaluation and management of atherogenic dyslipidemia: beyond low-density lipoprotein cholesterol — J.-P. Després et al
Canadian Medical Association Journal