**13. Coronary calcium score**

• The ratio of non-HDL cholesterol/HDL cholesterol can be considered as an alternative, but the HDL cholesterol used in the HEART SCORE provides a better risk estimate. (2b-C)

• Lp(a) should be recommended in selected case at high-risk, for reclassification at border-

• TC may be considered but is usually not enough for the characterization of dyslipidemia

• HDL cholesterol and non-HDL cholesterol/HDL cholesterol levels are not recommended

More than 30% of worldwide deaths are thought to be cardiovascular based and the frequency tends to increase due to changes in lifestyle and prolonged life. According to AHA 2016 statistics, in the United States, one in every 42 seconds loses his/her life due to cardiovascular reasons [19]. In Europe, the cardiovascular mortality rate is 4.1 million a year. A total of 1.8 million deaths, in other words 20% of all deaths, are due to ischemic heart disease. This is followed by cerebrovascular events with an annual death of 1.1 million. According to ESC data, 1.5 million deaths before the age of 75 and 710,000 deaths before the age of 65 are cardiovascular sources; half is due to coronary artery disease [20]. Deaths in all age groups, 51% of

Acute coronary syndrome is a clinical event that occurs when the coronary blood flow is reduced by thrombus on the rupture plaque and the myocardial oxygen requirement cannot be met. Acute coronary syndrome is broad spectrum which contains STEMI, nonSTEMI, unstable angina pectoris, and sudden cardiac death. In many cases, the thrombosis process begins with plaque rupture. Up to 25% of cases of acute coronary syndromes can begin with plaque erosion. Lymphocyte and macrophage activation and the inflammatory response is accompanied by atherothrombosis. There are clinical differences according to coronary collateral reserve and obstruction severity. This process occurs after a plaque rupture and is called Type 1 MI.

Atherosclerotic plaques that play an essential role in acute coronary syndrome are divided according to their structural characteristics: Plaque structure is with thin fibrous cap, dense necrotic core, high inflammatory cell density, and low smooth muscle content; it is called vulnerable plaque. Vulnerable plaque increases with hypertension, diabetes mellitus, elevated LDL, decreased HDL, and elevated ACE. Conversely, stabilized plaques with thick fibrous caps, poor necrotic cells, and dense extracellular matrix with low inflammatory content are

• LDL cholesterol is the main treatment target. (1-A)

before initiation of treatment. (2a-C)

women and 42% of men are cardiovascular.

**12. Coronary artery disease and cholesterol**

observed in individuals with low risk factors (**Figure 1**).

as treatment targets (Class 3).

**11. Epidemiology**

100 Cholesterol - Good, Bad and the Heart

• When available, apoB should be an alternative to non-HDL-C. (2a-C)

line risk, and in subjects with a family history of premature CVD. (2a-C)

The coronary calcium score began to be used in the 1990s and the method was prepared by Agatson et al. Zero coronary calcium score has a high negative predictive value. It is the most commonly used method. In the 2016 ESC Guidelines for Cardiovascular Disease Prevention, the use of coronary calcium scoring has been proposed for predicting cardiovascular risk in individuals with a SCORE risk threshold of 5–10%.

CARDIA study showed a correlation between elevated LDL or non-HDL cholesterol and coronary calcium score [23].
