TY - JOUR
T1 - Women with a low Framingham risk score and a family history of premature coronary heart disease have a high prevalence of subclinical coronary atherosclerosis
AU - Michos, Erin D.
AU - Vasamreddy, Chandrasekhar R.
AU - Becker, Diane M.
AU - Yanek, Lisa R.
AU - Moy, Taryn F.
AU - Fishman, Elliot K.
AU - Becker, Lewis C.
AU - Blumenthal, Roger S.
PY - 2005/12/1
Y1 - 2005/12/1
N2 - Background: The Framingham risk estimation (FRE) serves as the basis for identifying which asymptomatic adults should be treated with aspirin and lipid-lowering therapy in primary prevention. However, the FRE generally yields low estimates of 10-year "hard" coronary heart disease (CHD) event risk with few women (<70 years) qualifying for preventive pharmacologic therapy despite relatively high lifetime risk. We postulated that traditional risk factor assessment might fail to identify a sizeable portion of women with a sibling history for premature CHD as having advanced subclinical atherosclerosis. Methods: We studied 102 asymptomatic women (mean age 51 ± 7 years) who were the sisters of a proband hospitalized with documented premature CHD. Participants underwent risk factor assessment and multidetector computed tomography for coronary artery calcium (CAC) scoring. Based on FRE prediction of 10-year risk for hard CHD events, participants were classified as low risk (<10%) (n = 100), intermediate risk (10%-20%) (n = 2), or high risk (>20%) (n = 0). Significant subclinical atherosclerosis was defined as age-sex adjusted >75th percentile CAC scores. Results: Ninety-eight percent were at low risk (mean FRE of only 2% ± 2%). However, 40% had detectable CAC, 12% had CAC >100, and 6% had CAC ≥400. Based on CAC score percentiles, 32% had significant subclinical atherosclerosis and 17% ranked above the 90th percentile. Conclusion: Among women classified as low risk by FRE, a third had significant subclinical atherosclerosis. Sisters of probands with premature CHD appear to be a high-risk group and may warrant noninvasive screening for subclinical atherosclerosis to appropriately target individuals for more aggressive primary prevention therapy than what is currently recommended.
AB - Background: The Framingham risk estimation (FRE) serves as the basis for identifying which asymptomatic adults should be treated with aspirin and lipid-lowering therapy in primary prevention. However, the FRE generally yields low estimates of 10-year "hard" coronary heart disease (CHD) event risk with few women (<70 years) qualifying for preventive pharmacologic therapy despite relatively high lifetime risk. We postulated that traditional risk factor assessment might fail to identify a sizeable portion of women with a sibling history for premature CHD as having advanced subclinical atherosclerosis. Methods: We studied 102 asymptomatic women (mean age 51 ± 7 years) who were the sisters of a proband hospitalized with documented premature CHD. Participants underwent risk factor assessment and multidetector computed tomography for coronary artery calcium (CAC) scoring. Based on FRE prediction of 10-year risk for hard CHD events, participants were classified as low risk (<10%) (n = 100), intermediate risk (10%-20%) (n = 2), or high risk (>20%) (n = 0). Significant subclinical atherosclerosis was defined as age-sex adjusted >75th percentile CAC scores. Results: Ninety-eight percent were at low risk (mean FRE of only 2% ± 2%). However, 40% had detectable CAC, 12% had CAC >100, and 6% had CAC ≥400. Based on CAC score percentiles, 32% had significant subclinical atherosclerosis and 17% ranked above the 90th percentile. Conclusion: Among women classified as low risk by FRE, a third had significant subclinical atherosclerosis. Sisters of probands with premature CHD appear to be a high-risk group and may warrant noninvasive screening for subclinical atherosclerosis to appropriately target individuals for more aggressive primary prevention therapy than what is currently recommended.
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U2 - 10.1016/j.ahj.2005.02.037
DO - 10.1016/j.ahj.2005.02.037
M3 - Article
C2 - 16338271
AN - SCOPUS:28844499541
VL - 150
SP - 1276
EP - 1281
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 6
ER -