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Tables
Table
1. Medical Subject Headings and Free-Text Search Terms Used in Electronic Searches
Terms |
Medical Subject Headings |
Free-Text |
Disease-specific–related terms |
Hypertension
Hypertension/epidemiology/*prevention and control
Dyslipidemia*
Dyslipidemia*/epidemiology/*prevention and control
Hyperlipidemia*
Hyperlipidemia*/epidemiology/*prevention and control
Hypercholesterolemia
Cholesterol, LDL
Cholesterol, HDL
Cardiovascular disease*
Cardiovascular disease*/epidemiology/*prevention and control
Complications
|
Blood pressure, high
Hyperlipemia
Hyperlipidemia
Lipemia
Lipidemia
Lipid disorders
Cholesterol
Low-density lipoprotein cholesterol
High-density lipoprotein cholesterol
Triglycerides
Adverse events
Adverse effects
|
Screening and treatment-related terms |
Mass screening
Exercise
Diet
Utilization
Therapy
|
Screening
Screening trends
Exercise
Physical activity
Diet
Lipid analysis
Treatment
Disease management
Disease prevention
|
Other |
Cross-sectional survey
Health surveys
Review
Meta-analysis
Guideline
|
NHANES
NHIS
BRFSS
MEPS
NAMCS
Population survey
Systematic review
Meta-analysis
Clinical practice guideline
Evidence-based guidelines
Standards
|
Abbreviations: LDL, low-density lipoprotein; HDL, high-density lipoprotein; NHANES,
National Health and Nutrition Examination Survey; NHIS, National Health Interview Survey; BRFSS, Behavioral Risk Factor Surveillance System;
MEPS, Medical Expenditure Panel Survey; NAMCS, National Ambulatory Medical Care Survey.
Asterisk (*) indicates wildcard in search.
Table 2. Selected Characteristics of Randomized Controlled
Trials Examining Cardiovascular Effects of Diet
Study, Setting, and Qualitya |
Study Populationb |
Intervention |
Results |
Gerhard et al 2000 (20)
Academic: Oregon Health Sciences University
Portland, Oregon, United States
Moderate
|
22 healthy white and African American premenopausal women aged 18-45 y living in the Portland area who participated in a previous study |
Randomized crossover design assignment to diet order
Intervention — Low- to high-fat/cholesterol diet and high- to low-fat/cholesterol diet
Protocol — Follow randomly assigned order of diets. Start first diet x 4 wks; 4-wk washout period; follow other diet for 4 wks
|
Low-fat and cholesterol diets were associated with
- decreased TC
- decreased HDL-C
- decreased LDL-C
- increased TG
White women (n = 9) had higher VLDL-C cholesterol concentrations and TG than African American women (n = 13). Otherwise, no racial differences were noted.
Small sample sizes may have impaired ability to detect differences.
|
Pellizzer et al 1999 (21)
Hospital: Austin Hospital
Victoria, Australia
Low
|
25 healthy, nonsmoking, premenopausal women aged 18-45 y in 20% of ideal body weight |
Randomized, crossover design assignment to 1 of 2 diets
Intervention — 1st: Low in total and saturated fat (25%) and cholesterol; 2nd: High in total and saturated fat (40%) and cholesterol
Protocol — Follow randomly assigned order of diets. Start first diet,
follow for 2 wks; 2-wk washout; Follow other diet for 2 wks
|
Low-fat diets associated with
- decreased DBP
- decreased TC
- decreased HDL-C
- decreased LDL-C
- no significant change in SBP
- weight did not change significantly
|
Ginsberg et al 1998 (22)
Multicenter trials: Columbia University, Pennington Biomedical Research Center, Pennsylvania State University, University of Minnesota, United States
Moderate
|
39 healthy, normolipidemic, premenopausal women recruited from
4 research centers; mean age, 31 y |
Randomized, crossover design
Intervention — Diet A: Average American diet with 37% fat, including 16% SFA; diet B: Step 1 diet with 30% fat including 9% SFA; diet C: Low-SFA diet with 26% fat including 5% SFA
Protocol — Randomly assigned a diet sequence that includes each diet: ABC, ACB, BAC, BCA, CAB, or CBA
Assigned diets were followed for 8 wks, followed by 4- to 6-wk washout between diets, and next diet
|
Relative to average American diet, Step 1 and Low-SFA diets associated with
- decreased TC
- decreased HDL-C
- decreased LDL-C
- no significant change in TG
|
Abbreviations: TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglycerides; VLDL-C, very low-density lipoprotein cholesterol; DBP, diastolic blood pressure; SBP,
systolic blood pressure; SFA, saturated fatty acids.
a Quality was defined as ratings based on ECRI Institute 25-item validated instrument (19).
b Number of subjects limited to those who completed the study.
Table 3. Selected Characteristics of Randomized Controlled
Trials Examining Cardiovascular Effects of Exercise
Study, Setting, and Qualitya |
Study Populationb |
Intervention |
Results |
Ciolac et al 2010 (23)
Brazil
Moderate
|
44 healthy female college students
Mean age by group:
Aerobic interval training = 24.4 y; continuous exercise training = 26.6 y; control = 25.3 y
Intervention, n = 16; control, n = 12
|
Intervention. Five min warm up, 15 min of calisthenics, and either aerobic interval training (AIT, n = 16) or continuous exercise training (CET, n = 16) for 40 min for 3 times/wk for 16 weeks
Intensity. AIT = 50%-90% max ventilation oxygen uptake (VO2MAX)
CET = 60%-70% VO2MAX
|
Relative to controls, interventions associated with
- no significant change in TC
- no significant change in LDL-C
- no significant change in HDL-C
- no significant change in TG
- no significant change in SBP
- no significant change in DBP
|
Boreham et al 2005 (24)
Northern Ireland, UK
High
|
15 sedentary, but otherwise healthy, young female college students
Mean age, 18.8 y
Intervention, n = 8; control, n = 7
|
Intervention. Stair-climbing program 5 times/wk for 8 wks
Intensity. Progressive starting with 2 sets (199 stairs) at 90 steps/min and working up to 5 sets
|
Relative to controls, interventions associated with:
- decreased LDL-C
- no significant change in TC
- no significant change in HDL-C
- no significant change in TG
|
Kin Isler et al 2001 (25)
Ankara, Turkey
Moderate
|
45 sedentary female college student volunteers
Mean age by group: Step aerobics = 21.9 y; aerobic dancing = 20.2 y; control
= 21.9 y
Intervention, n = 30; control, n = 15
|
Intervention. Step aerobics (n = 15) or aerobic dancing (n =
15) for 45 min, 3 times/wk for 8 wks Intensity. Sixty to 70% heart rate reserve
|
Relative to controls, both interventions associated with
- decreased TC
- no significant change in TG
- no significant change in LDL-C
Relative to controls, step aerobics associated with increased HDL-C
|
LeMura et al 2000 (26)
Pennsylvania, United States
Moderate
|
45 college-aged, nonsmoking female students with no regular physical activity for 4 mo before study, and taking no medications known to alter lipid metabolism
Mean age = 20.4 y
Intervention, n = 33; control, n = 12
|
Intervention.
Resistance training (n = 11), aerobic training (n = 10), or cross training (n = 12) for
3 times/wk for 16 wks Intensity. Resistance = Nautilus 3 times per wk; aerobic = 3 times per wk; cross-training = aerobics 2 times/wk and Nautilus 2 times/wk
Control. No training during 16 wks.
|
Relative to controls, interventions associated with
- no significant change in TC
- no significant change in LDL-C
- no significant change in HDL-C
- no significant change in TG
|
Prabhakaran et al 1999 (27)
Virginia, United States
Moderate
|
24 sedentary, premenopausal healthy women recruited by campus newspaper and word of mouth
Mean age by group: resistance training, 28.0 y; control, 26.0 y
Intervention, n = 12; control, n = 12
|
Intervention. Supervised, intensive, resistance exercise training sessions 45-50 min/d, 3 d/wk for 14 wks
Control. Nonexercising
|
Relative to controls, intervention associated with
- decreased TC
- no significant change in LDL-C
- no significant change in HDL-C
- no significant change in TG
- no significant change in body mass
|
Duey et al 1998 (33)
Alabama, United States
Moderate
|
25 sedentary African American women
Mean age by group: intervention, 23.6 y; control, 22.2 y
Intervention, n = 16; control, n = 9
|
Intervention. Endurance exercise training sessions 20 min/d (plus warm-up and cool-down), 3 d/week for 6 wks
Intensity. Weeks 1-2: 60% peak oxygen uptake (VO2peak); weeks 3-4: 65% VO2peak; weeks 5-6: 70% VO2peak
Control. Usual diet and physical activity
|
Relative to controls, intervention associated with
- no significant change in SBP
- no significant change in DBP
|
Santiago et al 1995 (28)
Minnesota, United States
Moderate
|
27 mostly white, healthy female volunteers aged 22-40 y, nonsmokers, not pregnant, sedentary, body mass index <31 kg/m2
Intervention, n = 16; control, n = 11
|
Intervention. Brisk treadmill walking for 3 miles, 4 d/wk for 40 wks
Intensity. 72% maximal heart rate
Control. Sedentary
|
Relative to controls, intervention associated with
- no significant change in HDL-C
- no significant change in LDL-C
- no significant change in TC
- no significant change in TG
- no significant change in body composition
|
Boyden et al 1993 (29)
Arizona, United States
Moderate
|
88 white, healthy female volunteers aged 28-39 y, smoked ≤10 cigarettes/d, inactive, not overweight or obese
Intervention, n = 46; control, n= 42
|
Intervention. Resistance exercising for 1 hour, 3 d/wk for 5 mos
Intensity. Load major muscle groups in the arms, legs, trunk, and lower back
Control. Inactive
|
Relative to controls, intervention associated with
- decreased LDL-C
- decreased TC
- no significant change in HDL-C
- no significant change in TG
|
Hinkleman et al 1993 (30)
California, United States
Moderate
|
36 premenopausal female volunteers aged 25-45 y, not presently exercising or dieting, 10%-40% overweight, nonsmokers, no history of alcohol or drug abuse
Intervention, n = 18; control, n = 18
|
Intervention. Walking 45 min, 5 d/wk for 15 wks
Intensity. Sixty percent heart rate
Control. Non-exercising
|
Relative to controls, intervention associated with
- no significant change in LDL-C
- no significant change in TC
- no significant change in TG
- decreased HDL-C
- significant change in body weight
- no significant change in body fat
|
Katz et al 1992 (34)
Ohio, United States
Moderate
|
21 white, healthy female volunteers aged 18-28 y, nonsmokers, inactive, no history of cardiovascular disease
Intervention, n = 13; control, n= 8
|
Intervention. Low-intensity resistance exercise training on Nautilus 30 min/d,
3 d/wk for 6 wks
Control. Not trained
|
Relative to controls, intervention associated with
- no significant change in SBP
- no significant change in DBP
|
Duncan et al 1991 (31)
Texas, United States
Moderate
|
53 mixed-race, healthy women aged 20-40 y, nonsmokers,
sedentary, “light or nondrinkers”
Intervention, n = 43; control, n = 10
|
Intervention. Aerobic walking (n = 13), brisk walking (n = 12), or strolling (n = 18) 4.8 km, 5 d/wk for 24 wks
Intensity. Aerobic walkers, 8.0 km/h; brisk walkers, 6.4 km/h; strollers, 4.8 km/h
Control. Sedentary
|
Relative to controls, intervention associated with
- no significant change in seated blood pressure
- no significant change in TC
- no significant change in LDL-C
- no significant change in HDL-C
- no significant change in TG
|
Edin et al 1990 (32)
Minnesota, United States
Moderate
|
17 healthy, nonpregnant women aged 18-40 y, sedentary, nonsmokers with body weight within 80%-120% of standard body weight for height range
Intervention, n = 10; control, n = 7
|
Intervention. Aerobic exercise on trampoline 30 min, 5 d/wk for 11 wks
Intensity. Training heart rate zone of 70%-85% of maximal heart rate
Control. Sedentary
|
Relative to controls, intervention associated with
- no significant change in TC
- no significant change in HDL-C
- no significant change in TG
|
Oluseye et al 1990 (35)
Ibadan, Nigeria
Moderate
|
42 sedentary Nigerian women, aged 20-50 y
Intervention, n = 30; control, n = 12
|
Intervention. Interval Aerobic Training Protocol (ITP) (n = 15) or Continuous Aerobic Training Protocol (CTP) (n = 15) 50 min, 3 d/wk for 12 wks
Intensity. Progressive 65%-95% of maximal heart rate with increases of 5% every 2 wks
Control. Sedentary
|
Relative to controls, interventions associated with
- decreased SBP
- decreased DBP
|
Abbreviations: TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides; SBP, systolic blood pressure; DBP, diastolic blood pressure.
a Quality ratings based on ECRI Institute 25-item validated
instrument (20).
b Number of subjects limited to those who completed the study.
Table 4. Selected Characteristics of Randomized Controlled
Trials Examining Cardiovascular Effects of Diet and Exercise
Study, Setting, and Qualitya |
Study Populationb |
Intervention |
Results |
Esposito et al 2003 (39)
Naples, Italy
High
|
120 premenopausal, sedentary, obese, nonpregnant women aged 20-46 y recruited from the outpatient department for weight loss of the teaching hospital. Exclusion criteria: dieting within previous 6 mos, type 2 diabetes or impaired glucose tolerance, hypertension, cardiovascular disease, psychological problems, alcohol abuse, smokers, and any medication use
Intervention, n = 60; control, n = 60
|
Intervention. Individual counseling on increasing physical activity for 2 y; small group sessions on reducing dietary calories, personal goal setting, and self-monitoring
Intensity. Monthly sessions with a nutritionist and exercise trainer for 12 mos, bimonthly for 12 mos
Control. Monthly group education sessions
|
Relative to controls, intervention associated with
- decreased SBP
- decreased DBP
- decreased TG
- increased HDL-C
- no significant change in TC
Blood pressure and cholesterol were secondary outcomes of the study; primary outcomes were inflammatory markers.
No adjustments were made for multiple comparisons.
|
Janssen et al 2002 (36)
Ontario, Canada
Moderate
|
38 premenopausal, upper-body obese, women with stable weight in 6 mos before study, taking no medications, with regular menses
Mean age by group: diet and aerobics = 37.5 y; diet and resistance = 34.8 y; diet only = 40.1 y
Intervention, n = 25; control, n = 13
|
Intervention. Weight maintenance diet for 2 wks before pretreatment testing
Diet and aerobics (DA) (n = 11); diet and resistance (DR) (n = 14); weight reduction diet for 16 wks
Intensity. Diet = 1000 kcal deficit diet; DA = 15-60 min sessions of aerobic exercise for 5 d/wk; DR = 5-10 min cycling and 30 min sessions of resistance exercise 3 d/wk
Control. Diet only
|
Relative to controls, intervention associated with
- no significant change in TC
- no significant change in LDL-C
- no significant change in HDL-C
- no significant change in TG
|
Fogelholm et al 2000 (40) UKK Institute, Tampere, Finland
Moderate
|
74 premenopausal, healthy, sedentary female volunteers aged 30-45 y with body mass index 30-45 kg/m2 and stable weight over previous 3 months, nonbingeing, not taking medication other than birth control, and not pregnant, lactating, or smoker
Intervention, n = 47; control, n = 27
|
Intervention. Twelve wks weight reduction diet followed by maintenance program for 40 wks with weekly small group meetings and random assignment to walk-1 (n = 24), walk-2 (n = 23), or control (n = 27); unsupervised 2-year follow-up
Intensity. Walk-1 average 2-3 h weekly; walk-2 group average 4-6 h weekly
Control. Diet counseling with no change in exercise during maintenance program
|
Relative to controls, interventions associated with
- no significant change in TC
- no significant change in HDL-C
- no significant change in TG
- no significant change in SBP
- no significant change in DBP
Blood pressure and cholesterol were secondary outcomes of the study; primary outcomes were body weight, fat mass, and waist circumference.
|
Ågren et al 1991 (37)
University setting in Finland
Low
|
99 healthy female students (age not specified)
Intervention, n = 76; control, n = 23
|
Intervention. Fish diet (n = 22), exercise (n = 27), or fish diet and exercise (n = 27) for 14 wks
Intensity. Fish diet: offered meal containing 150g fish for 5 d/wk but uptake was 3.5 d/wk; aerobic exercise: advised to obtain 30 min moderate intensity aerobic activity ≥3 times/wk but uptake was 1.3 times/wk
Fish diet and aerobic exercise: as described above
|
Relative to controls, fish diet and exercise interventions associated with
- decreased TG
- no significant change in TC
- no significant change in LDL-C
- no significant change in HDL-C
|
Wood et al 1991 (38)
Stanford University, Palo Alto, California, USA
Moderate
|
112 healthy, sedentary, moderately overweight, nonsmoking, female volunteers aged 25-49 y, consuming <4 alcoholic drinks/d, not taking medication that could affect blood pressure or cholesterol, not lactating, pregnant, or taking oral contraceptives in past 6 mos, and not planning pregnancy in next 2 years
Intervention, n = 73; control, n = 39
|
Intervention. Diet-only (n = 31) or diet and exercise (n = 42)
Intensity. Daily diet consisting of 55% carbohydrates and 30% fat with ≤10% saturated fat and ≤300 mg cholesterol; weekly group sessions for 3 mos followed by every other week for 3 mos and monthly for 6 mos; supervised progressive aerobic exercise: brisk walking and jogging 3 d/wk at 25 min per session increasing to 45 min per sessions by 4th month
Control. Asked to maintain usual diet and exercise habits
|
Relative to controls interventions associated with
- decreased TC
- decreased LDL-C
- decreased TG
- decreased SBP
- decreased DBP
- no significant change in HDL-C
Relative to diet only group, diet and exercise associated with increased HDL-C
|
Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol.
a Quality ratings based on ECRI Institute 25-item validated instrument (20).
b Number of subjects limited to those who completed the study.
Table
5. National Blood Pressure and Cholesterol Screening Guidelines for
Diagnosing Hypertension and Dyslipidemia in Women
Developer and Year |
Who and When to Screen |
Risk Factors |
Diagnostic Criteria |
Hypertension |
American Academy of Family Physicians (AAFP) (42) 2011 |
WHO: Women aged ≥18 y
References US Preventive Services Task Force (USPSTF)
WHEN: Healthy and at-risk adults: not stated but refers to JNC7
|
References USPSTF Smoking, diabetes, abnormal blood lipid values, older age, sex, sedentary lifestyle, and obesity
|
References USPSTF SBP ≥140 mm Hg and/or DBP ≥90 mm Hg
≥2 elevated readings obtained on ≥2 visits over a period of 1 to several weeks
|
American College of Obstetricians and Gynecologists (ACOG) (62) 2007 |
WHO: Women aged ≥18 y
WHEN: Healthy and at-risk adults: not stated
|
African American, older age, prehypertension, family history of hypertension, lifestyle factors associated with hypertension |
See criteria used by the National Heart, Lung, and Blood Institute (NHLBI) Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) |
American Heart Association (AHA) (43) 2011 |
WHO: Women aged ≥20 y
WHEN: Healthy and at-risk adults: not stated, but refers to JNC7
|
High risk: CHD, cerebrovascular
disease, PAD, abdominal aortic aneurysm,
end-stage or chronic renal disease, diabetes mellitus, 10-y Framingham global
risk >20%
At risk: cigarette smoking, prehypertension, dyslipidemia, obesity, poor diet, physical inactivity, obesity, family history of premature CVD, metabolic syndrome, hypertension, dyslipidemia, evidence of vascular disease, subclinical atherosclerosis, metabolic syndrome, poor exercise capacity, systemic autoimmune collagen-vascular disease, history of preeclampsia, gestational diabetes, or pregnancy-induced hypertension
|
SBP ≥140 mm Hg or DBP ≥90 mm Hg, or SBP ≥130 mm Hg
or DBP ≥80 mm Hg if chronic kidney disease or diabetes is present |
Institute for Clinical Systems Improvement (ICSI) (44,45) 2008, 2009 |
WHO: Average-risk, asymptomatic women aged ≥18 y WHEN: Healthy adults: every 2 years
At-risk adults: prehypertension, 1 y; stage 1 hypertension, 2 mos; stage 2 hypertension, within 1 mo
|
Hypertension, age, diabetes mellitus, elevated LDL-C, low HDL-C, estimated GFR <60 mL/min, microalbuminuria, family history of premature CVD, obesity, physical inactivity, tobacco use, target organ damage to heart, brain, chronic kidney disease, PAD, or retinopathy |
Prehypertension:
SBP = 120-139 mm Hg or DBP = 80-89 mm Hg
Stage 1 hypertension:
SBP ≥140-159 mm Hg or, DBP ≥90-99 mm Hg
Stage 2 hypertension:
SBP ≥160 mm Hg or, DBP ≥100 mm Hg
Initial visit plus 2 follow-up visits, each including 2 measures per visit
|
NHLBI JNC7 (41) 2003 |
WHO: Adult women
WHEN: Healthy adults: every 2 y
At-risk adults: prehypertension, 1 y; stage 1 hypertension, 2 mos; stage 2 hypertension,
within 1 mo, or if SBP ≥180 mm Hg or DBP ≥110 mm Hg, treat immediately or
within 1 wk depending on clinical situation and complications
|
Hypertension, older age, diabetes mellitus, elevated LDL-C or total cholesterol or low HDL-C, estimated GFR <60 mL/min, family history of premature CVD, microalbuminuria, obesity, physical inactivity, tobacco usage, target organ damage to heart, brain, chronic kidney disease, PAD, or retinopathy |
Prehypertension:
SBP = 120-139 mm Hg or DBP = 80-89 mm Hg
Stage 1 hypertension, SBP ≥140 mm Hg or DBP ≥90 mm Hg
Stage 2 hypertension, SBP ≥160 mm Hg or DBP ≥100 mm Hg
Average of ≥2 seated blood pressure measurements per visit on ≥2 office visits
|
US Preventive Services Task Force (USPSTF) (46) 2007 |
WHO: Women aged ≥18 y without
known hypertension WHEN: Healthy and at-risk adults: not stated but refers to
JNC7 |
Smoking, diabetes, abnormal blood lipid values, age, sex, sedentary lifestyle, and obesity |
Initial visit ≥2 follow-up visits within a few weeks to 1 mo, each including 2 measures per visit |
Veterans Health Administration (VHA) (47) 2004, revised 2005 |
WHO: Women aged ≥17 y
WHEN: Healthy adults: annually
At-risk adults: stage 1 hypertension, 2 mos; stage 2 hypertension, within 1 mo
|
Tobacco use, dyslipidemia, diabetes mellitus, obesity, physical inactivity, microalbuminuria or estimated GFR <60 mL/min, age (>65 y for women), family history of CVD for women younger than 65 or men younger than 55 |
Stage 1 hypertension, SBP ≥140 mm Hg or DBP ≥90 mm Hg
Stage 2 hypertension, SBP ≥160 mm Hg or DBP ≥100 mm Hg
2 separate visits within 1-2 mo or sooner, each including ≥2 measures per visit
|
Dyslipidemia |
AAFP (42) 2011 |
WHO: At-risk women aged 20-45 y
References USPSTF.
WHEN: Healthy adults: No recommendation
At-risk adults: Uncertain; reasonable option is at least once every 5 years, shorter intervals for people who have lipid levels close to those warranting therapy,
longer intervals for those with repeatedly normal lipid levels
|
See USPSTF |
See USPSTF |
ACOG (62) 2007 |
WHO: Women aged ≥45 y and younger women with risk factors
WHEN: Healthy and at-risk adults: not stated but refers to Adult Treatment Panel III (ATP III)
|
Presence of CHD, diabetes, other clinical forms of atherosclerotic disease, cigarette smoking, hypertension, low HDL-C, family history of premature CHD, and older age |
Recommends fasting and no exercise, tobacco use, or caffeine before measurement
Refers to ATP III
|
AHA (43) 2011 |
WHO: Women aged ≥20 y
WHEN: Healthy and at-risk adults: no recommendation
|
High risk: CHD, CVD, PAD, abdominal aortic aneurysm, end-stage or chronic renal disease, diabetes mellitus, 10-y Framingham global risk of
≥10%
At risk: cigarette smoking, prehypertension, dyslipidemia, obesity, poor diet, physical inactivity, family history of premature CVD, metabolic syndrome, evidence of subclinical atherosclerosis, poor exercise capacity, systemic autoimmune collagen-vascular disease, history of preeclampsia, gestational diabetes, or pregnancy-induced hypertension
|
LDL-C ≥100 mg/dL
HDL-C ≤50 mg/dL
TG ≥150 mg/dL
Non-HDL-C ≥130 mg/dL
|
ICSI (45,63) 2009 |
WHO: Women aged ≥45 y and at-risk women aged 20-44 y
WHEN: Healthy adults: every 5 y
At-risk adults: every 3-12 mos
|
First-degree relatives with total cholesterol >300 mg/dL or history of premature CHD; personal history of CHD, CVD, peripheral vascular disease, diabetes mellitus, metabolic syndrome, current dyslipidemia
Also refers to ATP III definitions of high risk
|
TC ≥200 mg/dL
LDL-C ≥130 mg/dL
TG ≥200 mg/dL
HDL-C <40 mg/dL
|
NHLBI, National Cholesterol Education Program, ATP III (48) 2002 |
WHO: Women aged ≥20 y
WHEN: Healthy adults: at least once every 5 y
At-risk adults: more frequent measurements are required for persons with multiple risk factors or, in those with 0-1 risk factor, if the LDL-C level is only slightly below the goal level
|
High risk: CHD, or CHD risk equivalent including PAD, carotid artery disease, abdominal aortic aneurysm, type 2 diabetes, 10-y Framingham global risk of >20% due to multiple risk factors including cigarette smoking, hypertension, low HDL-C, family history of premature CHD, aged ≥55 y for women |
Optimal/Desirable: TC <200 mg/dL, LDL-C <100 mg/dL, HDL-C ≥60 mg/dL, TG <150 mg/dL
Above optimal: LDL-C = 100-129 mg/dL
Borderline high: TC = 200-239 mg/dL, LDL-C = 130-159 mg/dL, TG = 150-199 mg/dL
High: TC ≥240 mg/dL, LDL-C = 160-189 mg/dL, HDL-C <40 mg/dL, TG = 200-499 mg/dL
Very high: LDL-C ≥190 mg/dL, TG ≥500 mg/dL
|
USPSTF (64) 2008 |
WHO: At-risk women aged 20-45 y
WHEN: Healthy adults: no recommendation
At-risk adults: uncertain; reasonable options include every 5 y, shorter intervals for people who have lipid levels close to those warranting therapy, and longer intervals for those not at increased risk with repeatedly normal lipid levels
|
Diabetes, previous personal history of CHD or noncoronary atherosclerosis, family history of CVD before age 50 in male relatives or age 60 in female relatives, tobacco use, hypertension, obesity |
TC and HDL-C (fasting or nonfasting) Confirm abnormal screening test results with a repeated sample on a separate occasion, and the average of both results should be used for risk assessment |
VHA (65) 2006 |
WHO: All adult women aged ≥45 y and adult women <45 y with ≥1 risk factors
WHEN: Healthy adults: every 5 years
At-risk adults: more often if family history of premature CVD exists
|
Older age, family history of premature CVD, hypertension, or under treatment for hypertension, smoking, diabetes mellitus, abdominal obesity |
Fasting lipid profile including TC ≥240 mg/dL, HDL-C <40 mg/dL, TG >200 mg/dL, LDL-C ≥130 mg/dL, if calculated but consider direct measurement of LDL-C if TG >400
mg/dL |
Abbreviations: NHLBI, National Heart, Lung, and Blood
Institute; JNC 7, the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure; AAFP, American Academy of
Family Physicians; SBP, systolic blood pressure; DBP, diastolic blood pressure; CHD, coronary heart disease;
PAD, peripheral artery disease; CVD, cardiovascular disease; PAD, peripherial artery disease; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; GFR, glomerular filtration rate; TG, triglycerides; TC, total cholesterol.
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