Distribution of Coronary Artery Calcium Scores by Framingham 10-Year Risk Strata in the MESA (Multi-Ethnic Study of Atherosclerosis) Potential Implications for Coronary Risk Assessment

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:57

Article

Okwuosa, Tochi M.³  Greenland, Philip^1,2  Ning, Hongyan^1,2  Liu, Kiang^1,2  Bild, Diane E.⁴  Burke, Gregory L.⁵  Eng, John⁶  Lloyd-Jones, Donald M.^1,2 

[1] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL 60611 USA

[2] Northwestern Univ, Dept Med, Feinberg Sch Med, Chicago, IL 60611 USA

[3] Wayne State Univ, Sch Med, Div Cardiol, Detroit, MI USA

[4] NHLBI, Prevent & Populat Sci Program, NIH, Bethesda, MD 20892 USA

[5] Wake Forest Univ, Div Publ Hlth Sci, Sch Med, Wake Forest, NC USA

[6] Johns Hopkins Univ, Sch Med, Russell H Morgan Dept Radiol & Radiol Sci, Baltimore, MD USA

关键词: atherosclerosis;    coronary calcium;    coronary heart disease;    Framingham risk score;    low risk;    number needed to screen;    population;    risk factors;   

DOI  :  10.1016/j.jacc.2010.11.053

来源: Elsevier

【 摘 要 】

Objectives By examining the distribution of coronary artery calcium (CAC) levels across Framingham risk score (FRS) strata in a large, multiethnic, community-based sample of men and women, we sought to determine if lower-risk persons could benefit from CAC screening. Background The 10-year FRS and CAC levels are predictors of coronary heart disease. A CAC level of 300 or more is associated with the highest risk for coronary heart disease even in low-risk persons (FRS, <10%); however, expert groups have suggested CAC screening only in intermediate-risk groups (FRS, 10% to 20%). Methods We included 5,660 Multi-Ethnic Study of Atherosclerosis participants. The number needed to screen (number of people that need to be screened to detect 1 person with CAC level above the specified cutoff point) was used to assess the yield of screening for CAC. CAC prevalence was compared across FRS strata using chi-square tests. Results CAC levels of more than 0, of 100 or more, and of 300 or more were present in 46.4%, 20.6%, and 10.1% of participants, respectively. The prevalence and amount of CAC increased with higher FRS. A CAC level of 300 or more was observed in 1.7% and 4.4% of those with FRS of 0% to 2.5% and of 2.6% to 5%, respectively (number needed to screen, 59.7 and 22.7, respectively). Likewise, a CAC level of 300 or more was observed in 24% and 30% of those with FRS of 15.1% to 20% and more than 20%, respectively (number needed to screen, 4.2 and 3.3, respectively). Trends were similar when stratified by age, sex, and race or ethnicity. Conclusions Our study suggests that in very low-risk individuals (FRS <= 5%), the yield of screening and probability of identifying persons with clinically significant levels of CAC is low, but becomes greater in low-and intermediate-risk persons (FRS 5.1% to 20%). (J Am Coll Cardiol 2011; 57: 1838-45) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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