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Coronary plaque as a replacement for age as a risk factor in global risk assessment

  • Scott M Grundy
    Correspondence
    Address for reprints: Scott M. Grundy, MD, PhD, Center for Human Nutrition, Departments of Clinical Nutrition and Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9052
    Affiliations
    Department of Clinical Nutrition, Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA

    Department of Internal Medicine, Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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      Abstract

      Risk assessment is assuming an increasing role for identification of high-risk persons for intensive medical intervention to reduce risk for coronary heart disease (CHD). Of particular importance is the need to identify those persons with CHD risk equivalents who can be managed with the same intensity as patients with established CHD. For example, the National Cholesterol Education Program (NCEP) recently classified diabetes as a CHD risk equivalent. The NCEP also recommended use of Framingham risk scoring in persons with multiple (2+) risk factors to uncover others without diabetes who have CHD risk equivalents. One limitation of Framingham risk scoring, however, is that age becomes the dominant risk factor after age 50. Age is a surrogate for coronary atherosclerotic plaque burden, which is the true risk factor. However, for individuals, coronary plaque burden can vary greatly at any given age. For this reason, if coronary plaque burden could be measured accurately with noninvasive techniques, the degree of plaque burden could be used to replace age as a risk factor in Framingham scoring for risk prediction. This article describes a technique whereby such a replacement can be made.
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      References

        • Smith Jr, S.C
        • Blair S.N
        • Criqui M.H
        • Fletcher G.F
        • Fuster V
        • Gersh B.J
        • Gotto A.M
        • Gould K.L
        • Greenland P
        • Grundy S.M
        • et al.
        Preventing heart attack and death in patients with coronary disease.
        Circulation. 1995; 92: 2-4
        • Grundy S.M
        Primary prevention of coronary heart disease.
        Circulation. 1999; 100: 988-998
      1. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–2497.

        • Grundy S.M
        • Benjamin I.J
        • Burke G.L
        • Chait A
        • Eckel R.H
        • Howard B.V
        • Mitch W
        • Smith Jr, S.C
        • Sowers J.R
        Diabetes and cardiovascular disease.
        Circulation. 1999; 100: 1134-1146
        • Wilson P.W.F
        • D’Agostino R.B
        • Levy D
        • Belanger A.M
        • Silbershatz H
        • Kannel W.B
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Assmann G
        • Carmena R
        • Cullen P
        • Fruchart J.C
        • Jossa F
        • Lewis B
        • Mancini M
        • Paoletti R
        Coronary heart disease: reducing the risk: a worldwide view. International Task Force for the Prevention of Coronary Heart Disease.
        Circulation. 1999; 100: 1930-1938
        • Grundy S.M
        • Pasternak R
        • Greenland P
        • Smith Jr, S.C
        • Fuster V
        AHA/ACC scientific statement: assessment of cardiovascular risk by use of multiple-risk factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology.
        J Am Coll Cardiol. 1999; 34: 1348-1359
        • Grundy S.M
        • D’Agostino R.B
        • Mosca L
        • et al.
        Cardiovascular risk assessment in US cohort studies.
        Circulation. 2001; 104: 1-6
        • Constantinides P
        Plaque hemorrhages, their genesis and their role in supraplaque thrombosis and atherogenesis.
        in: Glagov S Newman W.P Schaffer S.A Pathobiology of the Human Atherosclerotic Plaque. Springer-Verlag, New York1990: 393-411
        • Ringqvist I
        • Fisher L.D
        • Mock M
        • Davis K.B
        • Wedel H
        • Chaitman B.R
        • Passamani E
        • Russell Jr, R.O
        • Alderman E.L
        • Kouchoukas N.T
        • et al.
        Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS).
        J Clin Invest. 1983; 71: 1854-1866
        • Emond M
        • Mock M.B
        • Davis K.B
        • Fisher L.D
        • Holmes Jr, D.R
        • Chaitman B.R
        • Kaiser G.C
        • Alderman E
        • Killip 3rd, T
        Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) Registry.
        Circulation. 1994; 90: 2645-2657
        • Grundy S.M
        Age as a risk factor.
        Am J Cardiol. 1999; 83: 1455-1457
        • Smith Jr, S.C
        • Amsterdam E
        • Balady G.J
        • Bonow R.O
        • Fletcher G.F
        • Froelicher V
        • Heath G
        • Limacher M.C
        • Maddahi J
        • Pryor D
        • et al.
        Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: tests for silent and inducible ischemia: Writing Group II.
        Circulation. 2000; 101: E12-E16
        • Greenland P
        • Abrams J
        • Aurigemma G.P
        • Bond M.G
        • Clark L.T
        • Criqui M.H
        • Crouse 3rd, J.R
        • Friedman L
        • Fuster V
        • Herrington D.M
        • et al.
        Prevention Conference V: Beyond secondary prevention: identifying the high-risk patients for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III.
        Circulation. 2000; 101: E16-E22
        • Crouse 3rd, J.R
        • Craven T.E
        • Hagaman A.P
        • Bond M.G
        Association of coronary disease with segment-specific intimal-medial thickening of the extracranial carotid artery.
        Circulation. 1995; 92: 1141-1147
        • O’Leary D.H
        • Polak J.F
        • Kronmal R.A
        • Manolio T.A
        • Burke G.L
        • Wolfson Jr, S.K
        Carotid-artery intima and medial thickness as a risk factor for myocardial infarction and stroke in older adults.
        N Engl J Med. 1999; 340: 14-22
        • Rumberger J.A
        • Schwartz R.S
        • Simons D.B
        • Sheedy 3rd, P.F
        • Edwards W.D
        • Fitzpatrick L.A
        Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy.
        Am J Cardiol. 1994; 73: 1169-1173
        • Rumberger J.A
        • Simons D.B
        • Fitzpatrick L.A
        • Sheedy P.F
        • Schwartz R.S
        Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area.
        Circulation. 1995; 92: 2157-2162
        • Guerci A.D
        • Spadaro L.A
        • Popma J.J
        • Goodman K.J
        • Brundage B.H
        • Budoff M
        • Lerner G
        • Vizza R.F
        Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and symptomatic adults.
        Am J Cardiol. 1997; 79: 128-133
        • Raggi P
        • Callister T.Q
        • Cooil B
        • He Z.X
        • Lippolis N.J
        • Russo D.J
        • Zelinger A
        • Mahmarian J.J
        Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography.
        Circulation. 2000; 101: 850-855
        • Miettinen T.A
        • Pyorälä K
        • Olsson A.G
        • Musliner T.A
        • Cook T.J
        • Faergeman O
        • Berg K
        • Pedersen T
        • Kjekshus J
        Cholesterol-lowering therapy in women and elderly patients with myocardial infarction or angina pectoris.
        Circulation. 1997; 96: 4211-4218
        • Sacks F.M
        • Tonkin A.M
        • Shepherd J
        • Braunwald E
        • Cobbe S
        • Hawkins C.M
        • Keech A
        • Packard C
        • Simes J
        • Byington R
        • Furberg C.D
        Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors.
        Circulation. 2000; 102: 1893-1900
        • The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group
        Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels.
        N Engl J Med. 1998; 339: 1349-1357
        • Pitt B
        • Rubenfire M
        Risk stratification for the detection of preclinical coronary artery disease.
        Circulation. 1999; 99: 2610-2612
        • Smith Jr, S.C
        • Greenland P
        • Grundy S.M
        AHA Conference Proceedings. Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: executive summary. American Heart Association.
        Circulation. 2000; 101: 111-116
        • O’Rourke R.A
        • Brundage B.H
        • Froelicher V.F
        • Greenland P
        • Grundy S.M
        • Hachamovitch R
        • Pohost G.M
        • Shaw L.J
        • Weintraub W.S
        • Winters Jr, W.L
        • et al.
        American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease.
        Circulation. 2000; 102: 126-140