The document discusses various factors related to assessing risk of coronary heart disease (CHD), including: 1) A 58-year-old man's risk factors including family history of heart disease, blood pressure, cholesterol levels, and current risk assessment scoring. 2) Methods for assessing absolute 10-year CHD risk such as the Framingham Risk Score and counting individual risk factors. 3) Newer tests beyond traditional risk factors like C-reactive protein and lipoprotein-associated phospholipase A2 that may help identify risk of heart attack or stroke.

1. Pumps & Pipes 1 Christie M. Ballantyne, M.D. Center for Cardiovascular Disease Prevention Methodist DeBakey Heart Center Baylor College of Medicine Houston, Texas Atherosclerosis

3. How do you know if you are at risk for a heart attack?

9. Assessing CHD Risk in Men Note: Risk estimates were derived from the experience of the Framingham Heart Study, a predominantly Caucasian population in Massachusetts, USA. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA . 2001;285:2486-2497. Step 2: Total Cholesterol Point Total 10-Year Risk Point Total 10-Year Risk <0 <1% 11 8% 0 1% 12 10% 1 1% 13 12% 2 1% 14 16% 3 1% 15 20% 4 1% 16 25% 5 2%  17  30% 6 2% 7 3% 8 4% 9 5% 10 6% Step 7: CHD Risk ATP III Framingham Risk Scoring TC Points at Points at Points at Points at Points at (mg/dL) Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79 <160 0 0 0 0 0 160-199 4 3 2 1 0 200-239 7 5 3 1 0 240-279 9 6 4 2 1  280 11 8 5 3 1 Step 1: Age Years Points 20-34 -9 35-39 -4 40-44 0 45-49 3 50-54 6 55-59 8 60-64 10 65-69 11 70-74 12 75-79 13 HDL-C (mg/dL) Points  60 -1 50-59 0 40-49 1 <40 2 Step 3: HDL-Cholesterol Systolic BP Points Points (mm Hg) if Untreated if Treated <120 0 0 120-129 0 1 130-139 1 2 140-159 1 2  160 2 3 Step 4: Systolic Blood Pressure Step 5: Smoking Status Points at Points at Points at Points at Points at Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79 Nonsmoker 0 0 0 0 0 Smoker 8 5 3 1 1 Age Total cholesterol HDL-cholesterol Systolic blood pressure Smoking status Point total Step 6: Adding Up the Points

13. What causes a heart attack?

14. Endothelial Dysfunction in Atherosclerosis Ross R. N Engl J Med 1999; 340:115–126.

15. Fatty-Streak Formation in Atherosclerosis Ross R. N Engl J Med 1999; 340:115–126.

16. Formation of an Advanced, Complicated Lesion in Atherosclerosis Ross R. N Engl J Med 1999; 340:115–126.

17. Unstable Fibrous Plaques in Atherosclerosis Ross R. N Engl J Med 1999; 340:115–126.

18. Are there other tests to identify better who might have a heart attack or stroke?

20. LDL LUMEN MEDIA INTIMA The Role of Lp-PLA 2 in CVD Lp-PLA2

21. Adhesion Molecules LUMEN MEDIA INTIMA Lp-PLA2 The Role of Lp-PLA 2 in CVD Oxidized LDL Cytokines Lyso-PC + OxFA LDL

22. LUMEN MEDIA INTIMA Lyso-PC + OxFA Lp-PLA2 Adhesion Molecules Cytokines Plaque Formation Foam Cell Monocytes Macrophage The Role of Lp-PLA 2 in CVD Oxidized LDL LDL

23. Association of Lp-PLA 2 and CRP with Incident Ischemic Stroke 5.52 CRP, mg/L Lp-PLA 2 ,  g/L Ischemic Stroke Hazard Ratio 95% CI 3.13 –41.41, p<0.001 (>3) (1 –3 ) (<1) (  422) (310 –422 ) (<310) 6.02 2.85 4.27 4.36 Ballantyne CM et al. Arch Intern Med 2005;165:2479-2484.

27. Intensity of lipid-modifying therapy is dependent upon the absolute risk for CHD events