The population at low risk of atherothrombotic disease

Background: There are two approaches to the determination of the population at risk of atherothrombotic disease: the herd approach and the targeted approach. In the former scenario, all people are treated, usually with lifestyle changes, but also with medications at times. In the latter scenario, only those deemed at risk of atherothrombotic disease are treated. The author has always favored the latter approach, but for the target approach to be effective, one must know the population at low risk of atherthrombotic disease. Objectives: The purpose of this manuscript is to demonstrate that the population at low risk of atherothrombotic disease can be readily identified and needless treatment can be avoided. Methods: The author has conducted a chart review of his family practice patients roster and separated out the cohort of those who developed some form of atherothrombtic disease from the general population cohort. Results: The author has shown that three major risk factors for atherothrombotic disease can accurately define the population at low risk of atherothrombotic disease: no use of cigarettes, lack of dyslipidemia, and lack of hypertension. Dyslipidemia is defined in terms of the Cholesterol retention Fraction, defined as the difference between low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, that difference divided by the low-density lipoprotein cholesterol, but also whenever low-density lipoprotein cholesterol exceeds 170mg/dl. Hypertension is defined as a systolic blood pressure of 140mmHG or higher or any blood pressure that is being treated. Additionally, the author has shown that in the absence of these three major risk factors, the presence of diabetes mellitus is not associated with early onset atherothrombotic disease. Conclusions: People who do not manifest the three major risk factors for atherothrombotic disease (cigarette smoking, dyslipidemia, and hypertension)are not at risk of early or middle-age onset atherothrombotic disease. Such people do not require therapy though the high blood sugar levels of uncontrolled diabetes mellitus will require treatment to prevent microvascular disease.