Framingham risk equation underestimates subclinical atherosclerosis risk in asymptomatic women

Erin Donnelly Michos, Khurram Nasir, Joel B. Braunstein, John A. Rumberger, Matthew J. Budoff, Wendy S Post, Roger S Blumenthal

Research output: Contribution to journalArticle

Abstract

Background: Coronary heart disease (CHD) is the leading cause of death among American women. Currently, global risk assessment derived by Framingham risk equation (FRE) is used to identify women at increased risk for CHD. Electron-beam computed tomography (EBCT) derived coronary artery calcium (CAC) scores are validated markers for future CHD events among asymptomatic individuals. However, the adequacy of FRE for identifying asymptomatic women with CAC is unknown. Methods and results: We studied 2447 consecutive non-diabetic asymptomatic females (55 ± 10 years). Based upon FRE, 90% were classified as low-risk (FRE ≤9% 10-year risk of hard CHD events), 10% intermediate-risk (10-20%), and none were considered as high-risk (>20%). Coronary artery calcium was present in 33%, whereas CAC ≥100 and CAC ≥400 were seen in 10 and 3% of women, respectively. Overall, 20% of women had age-gender derived ≥75th percentile CAC. According to FRE, the majority (84%) of women with significant CAC ≥75th percentile were classified as low-risk. Approximately half (45%) of low-risk women with ≥2 CHD risk factors and a family history of premature CHD had significant CAC. Conclusion: Framingham risk equation frequently classifies women as being low-risk, even in the presence of significant CAC. Determination of CAC may provide incremental value to FRE in identifying asymptomatic women who will benefit from targeted preventative measures.

Original languageEnglish (US)
Pages (from-to)201-206
Number of pages6
JournalAtherosclerosis
Volume184
Issue number1
DOIs
StatePublished - Jan 2006

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Atherosclerosis
Coronary Vessels
Calcium
Coronary Disease
X Ray Computed Tomography
Cause of Death

Keywords

  • Coronary artery calcification
  • Framingham risk equation
  • Subclinical atherosclerosis
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Framingham risk equation underestimates subclinical atherosclerosis risk in asymptomatic women. / Michos, Erin Donnelly; Nasir, Khurram; Braunstein, Joel B.; Rumberger, John A.; Budoff, Matthew J.; Post, Wendy S; Blumenthal, Roger S.

In: Atherosclerosis, Vol. 184, No. 1, 01.2006, p. 201-206.

Research output: Contribution to journalArticle

Michos, Erin Donnelly ; Nasir, Khurram ; Braunstein, Joel B. ; Rumberger, John A. ; Budoff, Matthew J. ; Post, Wendy S ; Blumenthal, Roger S. / Framingham risk equation underestimates subclinical atherosclerosis risk in asymptomatic women. In: Atherosclerosis. 2006 ; Vol. 184, No. 1. pp. 201-206.
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abstract = "Background: Coronary heart disease (CHD) is the leading cause of death among American women. Currently, global risk assessment derived by Framingham risk equation (FRE) is used to identify women at increased risk for CHD. Electron-beam computed tomography (EBCT) derived coronary artery calcium (CAC) scores are validated markers for future CHD events among asymptomatic individuals. However, the adequacy of FRE for identifying asymptomatic women with CAC is unknown. Methods and results: We studied 2447 consecutive non-diabetic asymptomatic females (55 ± 10 years). Based upon FRE, 90{\%} were classified as low-risk (FRE ≤9{\%} 10-year risk of hard CHD events), 10{\%} intermediate-risk (10-20{\%}), and none were considered as high-risk (>20{\%}). Coronary artery calcium was present in 33{\%}, whereas CAC ≥100 and CAC ≥400 were seen in 10 and 3{\%} of women, respectively. Overall, 20{\%} of women had age-gender derived ≥75th percentile CAC. According to FRE, the majority (84{\%}) of women with significant CAC ≥75th percentile were classified as low-risk. Approximately half (45{\%}) of low-risk women with ≥2 CHD risk factors and a family history of premature CHD had significant CAC. Conclusion: Framingham risk equation frequently classifies women as being low-risk, even in the presence of significant CAC. Determination of CAC may provide incremental value to FRE in identifying asymptomatic women who will benefit from targeted preventative measures.",
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