title: Risk stratification and selection for statin therapy: going beyond Framingham.
abstract: Decisions for statin therapy in the primary prevention of atherosclerotic cardiovascular disease are generally made using the 10-year Framingham Risk Score (FRS). Even when a family history of premature cardiovascular disease is taken into account, there is often ambiguity about the need for statin therapy for patients with a 10-year FRS of 5%-19% and low-density lipoprotein cholesterol <3.5 mmol/L. Current Canadian dyslipidemia guidelines recommend consideration of a diversity of other factors, including biochemical measurements and imaging studies to help determine whether the calculated FRS might be misleadingly low and whether statin therapy might, therefore, be prudent. However, efficient use of the plethora of secondary factors makes this decision process itself potentially ambiguous. This brief summary provides a practical approach for using clinical information, basic biochemical tests, and more specialized tests, such as carotid ultrasound and coronary artery calcium scoring, to identify groups of patients at greater risk for atherosclerotic cardiovascular disease than suggested by the FRS.
authors.affiliation: Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: fitchettd@smh.ca.
authors.forename: David H
authors.initials: DH
authors.lastname: Fitchett
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.affiliation: Montreal Heart Institute, Montreal, Québec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Gregoire
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Todd
authors.initials: T
authors.lastname: Anderson
authors.affiliation: Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: McPherson
mesh_terms: D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D003657:Decision Making; D050171:Dyslipidemias / Q000188:drug therapy; D004562:Electrocardiography; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008074:Lipoproteins / Q000097:blood; D024821:Metabolic Syndrome / Q000150:complications; D018579:Patient Selection; D018570:Risk Assessment / Q000379:methods*
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008074:Lipoproteins; D002097:C-Reactive Protein