Predictors of

Heart Disease:
What is the
Best Tool?
A LOOK AT THE ASCVD RISK
EQUATION AND THE TG/HDL RATIO

By Vy Doan, Dietetic Intern Class of 2016

Objectives
Who is at high risk for atherosclerotic cardiovascular
disease?

Assess components of the ASCVD risk equation

TG/HDL ratio- What is it?
Practical implications of both tools

ASCVD
ASCVD Includes:
Myocardial infarction or other acute
coronary syndrome
Transient ischemic attack (TIA)
Ischemic stroke
Risk Factors
Age
Family Hx of early CHD
Current Cigarette smoking
High BP
Low HDL

Clinical Signs
Generally asymptomatic
First sign can be fatal MI
S/Sx of Coronary Heart Diseas
Chest pain
Shortness of Breath
Dizziness
Palpilations

S/Sx of Hypertriglyceridemia
(TG>500 mg/dL)
Pancreatitis

Numbers to Know
Test

Healthy level

Total cholesterol

under 200 mg/dL

LDL (bad) cholesterol

under 100 mg/dL

HDL (good) cholesterol

over 40 mg/dL

Triglycerides

under 150 mg/dL

[1997]
HDL/Chol
Ratio

[1997]
TG/HDL
Ratio

[2013]
ASCVD
Risk
Equation

The ASCVD Risk

Equation: Current Validity
and Research
IS IT THE BEST TOOL?

Theres an App for That!

Published jointly by the
American College of
Cardiology (ACC) and the
American Heart Association
(AHA)
Estimates 10 year and
lifetime risks for ASCVD
Based on the 10 year
pooled cohort study in
2013.

Estimated 10-Year ASCVD Risk

Pooled Cohort Risk Assessment Equations
Primarily in PREVENTION
Predicts 10-year risk for ASCVD event
Used for 40-79 years old
African American, White, Other (for all other races)
Excluded Populations:
Heart Failure

Hemodialysis

Implementation of Risk Assessment Work Group Recommendations.

David C. Goff, Jr et al. Circulation. 2014;129:S49-S73

Copyright American Heart Association, Inc. All rights reserved.

 Total cholesterol: 170 mg/dL

HDL: 50 mg/dL

Systolic BP: 110 mm Hg

NOT taking medications for hypertension

NOT diabetic
NOT smoker

Whats the Cut-Off Point?

A high level of evidence for an ASCVD risk-reduction
benefit from initiation of moderate or high-intensity statin
therapy in individuals 40 to 75 years of age with

>7.5% estimated 10-year ASCVD risk was found

(Section 4.7).
-AHA Guidelines

Who Gets the Statins?

Intensity

Criteria

Moderate

1. Diabetes
2. 10 year risk of 5% - <7% (no DM,
LDL 70-189)
3. ASCVD > 75 years old

Moderate-High

10 year risk 7.5% (No DM, LDL

70-189)
1. ASCVD Risk 75 years old
2. LDL > 190 (familial
hypocholesteremia)
3. Diabetes + 10 year risk 7.5%

High

TG/HDL Ratio?
IS IT THE BEST TOOL?

TG

HDL

The Numbers
RATIO
2
4
6

STATUS
IDEAL
High
Much Too High

TG/HDL is one of the most potent predictors of heart disease

Harvard Lead Study
High TG alone increased risk of heart attack nearly 3-fold.
340 heart attack pts. vs. 340 healthy
Higher TG/HDL ratio= 16 x the risk of heart attack vs. lowest TG/HDL ratio.
(Circulation 1997;96:2520-2525)

What is the Best

Predictor?
THE AWAITED QUESTION.

Which clinical risk scoring method best predicts the

prevalence and prognosis of coronary artery disease?

The ASCVD risk estimation system

improved prognostic power for
predicting long-term mortality than
previous risk stratification
methods.
-Cho, Achenbach, Berman, et. al, Journal of the American College of
Cardiology 2015.

From: WHICH CLINICAL RISK SCORING METHOD BEST PREDICTS THE PREVALENCE AND PROGNOSIS OF
CORONARY ARTERY DISEASE? RESULTS FROM A PROSPECTIVE MULTICENTER INTERNATIONAL
STUDY OF 1,096 PATIENTS
J Am Coll Cardiol. 2015;65(10_S). doi:10.1016/S0735-1097(15)61474-7

Date of download: 10/18/2015

Copyright The American College of Cardiology. All rights reserved.

Take Aways
The ASCVD risk equation predicts 10 year risk
Primarily in PREVENTION
Does not necessarily mean it is the best...
TG/HDL ratio
Chol/HDL ratio

#1- Lifestyle Modification

(Thats us!)

Thank you! Questions?

References

2013 Prevention Guidelines ASCVD Risk Estimator - American College of Cardiology. (n.d.). Retrieved
October 20, 2015.

Andrus, B., & Lacaille, D. (n.d.). 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk.
Journal of the American College of Cardiology, 2886-2886.

Cho, I., Valenti, V., & Achenbach, S. (n.d.). WHICH CLINICAL RISK SCORING METHOD BEST
PREDICTS THE PREVALENCE AND PROGNOSIS OF CORONARY ARTERY DISEASE? RESULTS
FROM A PROSPECTIVE MULTICENTER INTERNATIONAL STUDY OF 1,096 PATIENTS. Journal of the
American College of Cardiology, 65(10). doi:10.1016/S0735-1097(15)61474-7

Prevent a Heart Attack: Know Your Ratio? (n.d.). Retrieved October 20, 2015.