Abstract
A single risk factor determination may not lead to a correct classification of an individual's risk of ACVD. Analyses of risk factor trajectories and effort to express a cumulative exposition, dependent on the duration and intensity of exposure, seem to be the right direction to refine the risk determination.
In the case of plasma cholesterol levels, the effect of lifelong exposure on increased risk of ACVD is evident in carriers of cholesterol-raising mutations (familial hypercholesterolemia, primarily mutations within the LDL-receptor gene). In contrast, a lower risk of ACVD has been described in carriers of mutations in PCSK9 (associated with lower cholesterol levels).
Differences in risk rates for different lifetime trajectories of lipid levels have also been mentioned. Individually, it is much more severe if the identical final cumulative exposure is reached primarily due to exposure at a younger age (up to 40, max. 45 years of age).
This highlights the importance of early detection of at-risk individuals and targeted intervention at younger rather than at older ages.