In the general population, they may or may not predict risk independently of PCE. But in the clinician patient risk discussion they can be useful for identifying specific factors that in- fluence risk. Their presence helps to confirm a higher risk state and thereby supports a decision to initi- ate or intensify statin therapy. They are useful for clarifying which atherogenic factors are present in a particular patient. And in some patients, certain risk- enhancing factors carry greater lifetime risk than de- noted by 10-year risk prediction in the PCE. Finally, several risk-enhancing factors may be specific targets therapy beyond those of the PCE. A few comments may illustrate the potential use- fulness of risk-enhancing factors in the patient discus- sion. LDL-C 160 mg/dL ( 4.1 mmol/L), apoB 130 Table 6. Risk-Enhancing Factors for Clinician Patient Risk Discussion Risk-Enhancing Factors Family history of premature ASCVD (males, age <55 y; females, age <65 y) Primary hypercholesterolemia (LDL-C, 160 189 mg/dL [4.1 4.8 mmol/L); non HDL-C 190 219 mg/dL [4.9 5.6 mmol/L])* Metabolic syndrome (increased waist circumference, elevated triglycerides [>150 mg/dL], elevated blood pressure, elevated glucose, and low HDL-C [<40 mg/dL in men; <50 in women mg/dL] are factors; tally of 3 makes the diagnosis) with or without albuminuria; not treated with dialysis or kidney transplantation) Chronic inflammatory conditions such as psoriasis, RA, or HIV/AIDS History of premature menopause (before age 40 y) and history of pregnancy-associated conditions that increase later ASCVD risk such as preeclampsia High-risk race/ethnicities (eg, South Asian ancestry) Lipid/biomarkers: Associated with increased ASCVD risk Persistently* elevated, primary hypertriglyceridemia ( 175 mg/dL); If measured: Elevated high-sensitivity C-reactive protein ( 2.0 mg/L) Elevated Lp(a): A relative indication for its measurement is family history of premature ASCVD. 