SCOREa (10-year risk; %)
Framinghamb (10-year risk; %)
Vascular and/or metabolic morbidity
Manifest coronary heart disease (CHD)
Ischemic stroke or transitory ischemic attack (TIA) + evidence for atherosclerosis
Peripheral arterial occlusive disease (PAOD)
Type 2 diabetes
Type 1 diabetes with end-organ damage (EOD; e. g., albuminuria)
Moderate to severe nephropathy
Progressive or recurrent CHD in spite of LDL‑C < 100 mg/dl
Familial hypercholesterolemia (FH)
Type 1 diabetes + age > 40 years without target-organ disease
Distinctly increased individual risk factors (e. g., familial hypertension, severe hypertension)
(mostly < 10)
Assessment of manifest atherosclerosis
Coronary heart disease (CHD): status post myocardial infarction (MI) or stent/percutaneous transluminal coronary angioplasty, bypass surgery, angiographically verified CHD, ergometrically or scintigraphically proven myocardial ischemia;
Cerebrovascular angiopathy: ischemic stroke or transitory ischemic attack (TIA) with evidence of atherosclerotic changes in the carotids, hemodynamically relevant carotid stenosis;
Peripheral arterial occlusive disease (PAOD);
Abdominal aortic aneurysm.
Ascertainment of additional risk factors
Age (men: > 45 years; women: > 55 years);
A positive family history of premature CHD (male first-degree relatives < 55 years; female first-degree relatives < 65 years);
Hypertension (RR > 130/80 mmHg in 24-hour measurements or > 135/85 mmHg as a mean of self-measurement, or antihypertensive medication);
HDL-C (men: < 40 mg/dl; women: < 50 mg/dl).
Risk projection and classification
Subjects with a maximum of one classic risk factor according to the section “Ascertainment of additional risk factors” are allocated to the lowest risk category (Tab. 1).
In individuals showing no manifest atherosclerosis according to the section “Assessment of manifest atherosclerosis”, yet with two or more risk factors according to the section “Ascertainment of additional risk factors”, risk assessments are performed with the SCORE tables  (or, alternatively, Framingham tables ).
Subjects presenting with manifest coronary, cerebral, or peripheral atherosclerosis according to the section “Assessment of manifest atherosclerosis”, those with type 2 diabetes or type 1 diabetes and end-organ damage (EOD), and those with moderate or severe nephropathy are allocated to the group at a very high risk (Tab. 1).
Lipoprotein(a) (Lp[a]): > 30 mg/dl,
Lipoprotein-associated phospholipase A2: > 200 ng/ml,
High-sensitivity C‑reactive protein (hsCRP): > 3 mg/l,
Hyperhomocysteinemia: > 1.6 mg/l (12 μmol/l),
Carotid intima-media thickness: > 800 μm,
Ankle-brachial index: < 0.9,
Coronary calcium score: > 75th percentile,
FH (see “Familial hypercholesterolemia” section),
Metabolic syndrome (MS; see “Diabetes mellitus” section),
Impaired glucose tolerance.
Target values of LDL‑C reduction
LDL‑C target value (mg/dl)
Non-HDL-C target valuea (mg/dl)
LDL‑C threshold value for the initiation of medical treatment (mg/dl)
Medical LDL‑C reduction
HDL-C and TG management
Strategies for meeting target values
LDL‑C initial value (mg/dl)
Reductions required to meet target values (%)
< 70 mg/dl (very high risk)
< 100 mg/dl (high risk)