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Conditional Risk Factors for Atherosclerosis - Mayo Medical ...

Conditional Risk Factors for Atherosclerosis - Mayo Medical ...

Conditional Risk Factors for Atherosclerosis - Mayo Medical

Communiqué July 2005 A M a y o R e f e r e n c e S e r v i c e s P u b l i c a t i o n Volume 32 Number 7 Feature Conditional Risk Factors for Atherosclerosis Inside Education Calendar Test Updates • HNPCC Gene Mutation Testing Changes • Mycophenolic Acid Method Change New Test Announcements • BCR/ABL mRNA Detection, Quantitative, Reverse Transcription- Polymerase Chain Reaction (RT-PCR) • Busulfan, Intravenous Dose, Area Under the Curve (AUC), Plasma • hMLH1/hMSH2 Mutation Screen • Lipoprotein Metabolism Profile • SSO Class I Typing • West Nile Virus RNA Detection by Rapid Polymerase Chain Reaction (PCR) Conditional Risk Factors for Atherosclerosis Conditional risk factors for cardiovascular disease are a hot topic in medicine today. Expanding knowledge about both the analytes and their relationship to the development of atherosclerosis is rapidly opening new doors for detection and monitoring. The following article, adapted from Mayo Clinic Proceedings (2005;80(2):219- 230), provides an overview of the newest information about conditional risk factors and their possible use in patient care. Testing for these conditional risk factors is now available from Mayo Medical Laboratories (MML) as #84208 Extended Cardiovascular Risk Marker Panel. This assay provides a comprehensive result, including Framingham score, cholesterol measurements, and conditional risk factors. The concept of cardiovascular risk factors arose from the Framingham Heart Study, a landmark study in cardiovascular disease epidemiology that established older age, male sex, diabetes, hypertension, dyslipidemia, and smoking as the major risk factors for coronary heart disease (CHD). Subsequent advances in our understanding of the pathogenesis of atherosclerotic vascular disease have stimulated interest in the so-called novel risk factors for CHD. The study of these risk factors is important for at least 3 reasons. First, the ability to accurately predict the CHD risk of a specific individual based on his or her conventional risk factor profile is limited. Second, conventional risk factors explain less than 50% of the variability in quantitative measures of atherosclerotic vascular disease (assessed by coronary angiography or electron beam computed tomography). Novel biochemical and genetic factors are likely to be associated with the residual variability in measures of atherosclerotic vascular disease. Third, the risk of CHD varies among different ethnic groups, and novel risk factors may partly explain the variation. Risk factor assessment is an important first step in primary prevention and guides the intensity of efforts to reduce a patient’s CHD risk. Currently, 2 algorithms for assessing cardiovascular risk are recommended in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines. The first algorithm involves counting major risk factors and then estimating the 10-year probability of CHD based on an equation derived from the Framingham Heart Study. The second algorithm identifies the presence of the metabolic syndrome. These predictive models have a lower than desired accuracy in predicting CHD risk in an individual patient, thereby stimulating the search for new tools to refine risk assessment. In particular, there is intense interest in evaluating circulating biomarkers related to the atherosclerotic process as well as newer imaging modalities and tests of arterial function that might add to our ability to predict CHD risk (Figure 1). Figure 1. The coronary heart disease risk assessment pyramid. www.mayoreferenceservices.org/communique/ 7/05

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