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Age, gender, hypertension, tobacco use, hypercholesterolemia, and diabetes have long been recognized as risk factors for cardiovascular disease (CVD) in women.1,2 These factors often act together to increase this risk. Multiple algorithms utilizing these and other risk factors have been developed for assessment of CVD risk in women.1,2,3,4,5,6,7 Traditionally, these algorithms have focused on short term, or risk of CVD in a 10-year time frame. These risk scores are used to identify women who may benefit from early aggressive interventions, including diet and lifestyle modifications and lipid-lowering and antihypertensive medications. More recently, focus has shifted to assessment of lifetime risk of CVD as well as use of measures of subclinical atherosclerosis in risk assessment in women. This chapter will discuss risk assessment for CVD in women, including global risk assessment algorithms, use of nontraditional risk factors, and markers of subclinical atherosclerosis and risk factors for CVD that are unique to women.



Of these scores, the Framingham risk score, as it is incorporated into the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol (Adult Treatment Panel III) (ATP III),3 is the most commonly used. For each risk factor (age, total cholesterol, smoking status, HDL, and systolic blood pressure) a point value is assigned (see Table 3-1) and an absolute 10-year risk for coronary heart disease can be determined (see Table 3-2). An online ATP III risk score calculator can be found at: Based on the risk factor profiles and calculated 10-year risk of CVD, patients are stratified into 3 risk categories with different goal of low-density lipoprotein (LDL) and non–high-density lipoprotein (non-HDL) levels (see Table 3-3).

TABLE 3-1Estimate of 10-Year Risk for Women (Framingham Point Scores)3

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