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Coronary plaque as a replacement for age as a risk factor in global risk assessment
1Department of Clinical Nutrition, Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9052, USA. scott.grundy@utsouthwestern.edu
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Identifying coronary atherosclerotic plaque burden can improve coronary heart disease (CHD) risk assessment. Measuring plaque burden noninvasively may replace age in risk scoring for better prediction of CHD risk equivalents.
Area of Science:
- Cardiology
- Medical Diagnostics
- Preventive Medicine
Background:
- Risk assessment is crucial for identifying individuals needing intensive intervention for coronary heart disease (CHD).
- Diabetes is classified as a CHD risk equivalent, and Framingham risk scoring is used for individuals with multiple risk factors.
- Current risk scoring methods have limitations, as age is a dominant factor after 50, while coronary plaque burden is the true underlying risk.
Purpose of the Study:
- To propose a method for measuring coronary atherosclerotic plaque burden noninvasively.
- To explore replacing age with measured coronary plaque burden in risk assessment models.
- To enhance the accuracy of predicting CHD risk equivalents.
Main Methods:
- The study describes a technique for accurately measuring coronary atherosclerotic plaque burden using noninvasive methods.
- This technique aims to quantify the actual plaque burden in individuals.
- The proposed method facilitates the replacement of age as a risk factor in established scoring systems.
Main Results:
- Accurate measurement of coronary plaque burden can provide a more precise risk assessment than using age alone.
- Noninvasive techniques allow for direct quantification of the risk factor (plaque burden).
- This approach can identify individuals with CHD risk equivalents more effectively.
Conclusions:
- Measuring coronary atherosclerotic plaque burden noninvasively offers a superior alternative to using age in CHD risk prediction.
- This method can refine risk stratification for intensive medical intervention.
- The technique described has the potential to improve the management of individuals at risk for coronary heart disease.
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.