The term risk factor was invented by a leader of the Framingham Heart Study in 1961.1 Since then, the concept of a risk factor has become so deeply embedded into cardiovascular disease (CVD) prevention and practice that clarifications about the definition of a normal risk factor would seem unnecessary. Yet, whereas it is easy to discern what is normative at the population level, clinicians continue to desire to label risk factor levels normal, perhaps in an attempt to reassure patients that they are in the broad part of the population distribution rather than at an extreme. A case in point is a recent study2 on normal low-density lipoprotein (LDL) cholesterol, which was defined, surprisingly, as any level up to 160 mg/dL (to convert to mmol/L, multiply by 0.0259).
Greenland P, Lloyd-Jones DM. Defining the New Normal in Cardiovascular Risk Factors. JAMA Cardiol. 2018;3(9):789–790. doi:10.1001/jamacardio.2018.1576
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