Vega GL, Wang J, Grundy SM, et al. - Atherosclerotic cardiovascular disease (ASCVD) risk can be estimated using pooled cohort equation (PCE) tools. This study revealed that three or more enhancing risk factors in intermediate risk individuals can complement PCE-estimated 10-year risk as well as can guide the patient-provider discussion toward employment of lipid-lowering therapy.

• In some US subpopulations, inaccuracy of PCEs risk estimate has been noted.

• Addition of risk enhancing factors has been suggested by recent cholesterol guidelines, to enhance risk evaluation for selection of statin therapy.

• In this study, frequencies of various risk enhancing biomarkers were assessed in NHANES participants at intermediate risk (7.5 -<20% 10-year risk for ASCVD).

• The prevalence of selected risk-enhancing biomarkers was determined, and it was found that 25% of NHANES population had intermediate risk for ASCVD.

• Presence of ≥ 1 biomarkers, similarly in women and men, was found in 85% of this subpopulation, with a third having ≥3 abnormal markers.

• The observed frequencies were not age-associated, except in those 40-49 years, in whom > 40% were identified to have ≥3 abnormal biomarkers.

• It made little difference if LDL cholesterol, non-HDL-cholesterol or apolipoprotein B was employed as the atherogenic lipoprotein.