Women with a low Framingham risk score and a family history of premature coronary heart disease have a high prevalence of subclinical coronary atherosclerosis

Erin D. Michos, Chandrasekhar R. Vasamreddy, Diane M. Becker, Lisa R. Yanek, Taryn F. Moy, Elliot K. Fishman, Lewis C. Becker, Roger S. Blumenthal

Research output: Contribution to journalArticlepeer-review

96 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1276-1281
Number of pages6
JournalAmerican heart journal
Volume150
Issue number6
DOIs
StatePublished - Dec 1 2005

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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