Who exceeds ATP-III risk thresholds? Systematic examination of the effect of varying age and risk factor levels in the ATP-III risk assessment tool

Objective. We sought to determine the levels of risk factors required to exceed threshold values of intermediate (>= 10%) or high (>20%) predicted 10-year risk for coronary heart disease using the Adult Treatment Panel III (ATP-III) Risk Assessment Tool. Methods. Continuous risk factor values were entered into the risk assessment tool to examine levels of predicted 10-year risk. Both individual risk factors and the joint effects of varying multiple risk factors were systematically examined. Results. Women only exceed 10% risk at ages >= 70 with single risk factors of HDL-cholesterol levels <30 mg/dL or systolic blood pressure > 170 mm Hg. Women <= 65 only exceed 10% risk if they are smokers with low HDL-cholesterol levels. In contrast, single risk factors can cause men over 45 to exceed 10% or 20% predicted 10-year risk. Combinations of only modestly elevated risk factors cause many men to exceed 10% risk at ages >= 45, and to exceed 20% risk at ages >= 55. Conclusions. Because such high-risk factor levels are required for men <45years and women <65 years to exceed ATP-III risk thresholds, additional means for risk communication may be needed for individuals with elevated risk factors in these age ranges. (C) 2008 Elsevier Inc. All rights reserved.