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[Cardiac risk in men with angiographically normal coronary arteries or minimal coronary arteriosclerosis]
1Abteilung Kardiologie/Rehabilitation, Herz-Kreislauf-Klinik Bevensen AG, Römstedter Str. 25, 29549 Bad Bevensen, Germany.
Insights
Men aged 53 without coronary artery disease (CAD) but with high PROCAM scores face significant subclinical atherosclerosis and cardiac events. This suggests a unified approach to cardiac event prevention is needed, blurring lines between primary and secondary prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Vascular Biology
Background:
- Global cardiac risk assessment is crucial for effective preventive strategies.
- Distinguishing between primary and secondary prevention may not always be appropriate for cardiac events.
Purpose of the Study:
- To estimate the 10-year cardiac risk in men without clinically evident coronary artery disease (CAD).
- To correlate cardiac risk scores with the extent of subclinical coronary arteriosclerosis.
- To evaluate the occurrence of cardiac events in relation to baseline risk stratification.
Main Methods:
- Retrospective study of 54 men (mean age 53.1 years) without clinical CAD.
- Assessment of 10-year cardiac risk using PROCAM Score Scheme and FRAMINGHAM Scoring System.
- Coronary angiography to evaluate coronary artery disease extent (minimal arteriosclerosis <35% luminal diameter reduction).
- Semiquantitative estimation of arteriosclerosis by counting affected vessel segments (S).
- Follow-up for cardiac events (sudden cardiac death, myocardial infarction) over 10 years.
Main Results:
- Mean 10-year risk (PROCAM/FRAMINGHAM) was 14.0%/14.1%.
- Significant linear relation found between the number of arteriosclerotic segments (S) and PROCAM risk (r=0.97, p<0.025).
- Men with high PROCAM risk (>20%) showed significantly more arteriosclerotic segments (S=4.1) compared to low (<5%, S=0.8) and moderate (5-20%, S=2.4) risk groups (p<0.005).
- Cardiac events occurred in 23.8% of men with mild/moderate risk and 38.5% of men with high risk.
- Total cardiac mortality was 7.1%.
Conclusions:
- Men aged 53 without clinical CAD but with high 10-year PROCAM risk scores exhibit a high prevalence of subclinical coronary arteriosclerosis.
- These individuals have an increased probability of experiencing future cardiac events.
- The findings suggest that a strict separation between primary and secondary cardiac prevention strategies may be outdated.
Abstract:
It is accepted that the assessment of the global cardiac risk for the occurrence of a coronary event is basically for preventive strategies. In a retrospective study, we have estimated the initial 10-year risk in 54 consecutive men (mean age 53.1 years) without clinically coronary artery disease (CAD) by using the PROCAM Score Scheme and the FRAMINGHAM Scoring System. All individuals underwent coronary angiography for diagnostic reasons. Inclusion criteria were angiographically normal coronary arteries or coronary vessels with minimal arteriosclerosis (luminal diameter reduction <35%). The extent of initial coronary arteriosclerosis was estimated semiquantitatively by the number of wall changed vessel segments S (proximal, medial, distal) of the 3 large epicardial coronary arteries. Individuals were divided into 3 risk categories with a 10-year risk/PROCAM <5% (gr. I), 5-20% (gr. II) and >20% (gr. III). The mean 10-year risk/PROCAM and FRAMINGHAM of the entire group was 14.0 and 14.1%, respectively. The number of vessel segments with minimal arteriosclerosis averaged S=2.6. There was a significant linear relation between the number of arteriosclerotic segments, grouped by S=0, 1-2, 3-4, >4 and the mean corresponding 10-year risk/PROCAM (r=0.97; p<0.025). The mean 10-year risk/PROCAM and FRAMINGHAM in gr. I was 2.1+/-1.1 and 5.1+/-3.5%, in gr. II 11.1+/-4.4 and 14.5+/-7.1% and in gr. III 25.4+/-3.3 and 20.4+/-6.2%, respectively (gr. I vs II vs III: p<0.005). In gr. I an average of S=0.8+/-1.4 segments, in gr. II of S=2.4+/-1.8 and in gr. III of S 4.1+/-1.8 vessel segments revealed initial coronary arteriosclerosis (gr. I vs II vs III: p<0.01 <0.0025, respectively). In 42 of the 54 men (78%) there were 10-year follow-up data regarding sudden cardiac death, fatal and non-fatal myocardial infarction available. Thirty-two men of the follow-up group (78%) showed no cardiac event (gr. A, mean age 53.3+/-8.3 years). In 10 men (23.8%, 95% CI 19.7-32.5%) a fatal or non-fatal event occurred (gr. B, mean age 55.6+/-7.5 years). At the beginning of the study, the 10-year risk/PROCAM and FRAMINGHAM in gr. A was 12.0+/-9.3 and 14.1+/-8.0%, respectively. In gr. B the estimated 10-year risk was 18.7+/-8.0% (gr. A vs B: p<0.025) and 17.6+/-7.6%, respectively (gr. A vs B: p=ns). No cardiac event occurred in the low risk group <5% (mean 2.4+/-1.2%). In 23.8% (95% CI 19.2-36.8%) of the group with mild or moderate risk (5-20%, mean 10.4+/-4.1%) and in 38.5% (95% CI 29.5-53.1%) of the high risk group (>20%, mean 25.6+/-3.3%) a fatal or non-fatal event occurred. The total cardiac mortality was 7.1% (95% CI 6.6-15.1%). Our study indicates that men mean aged 53 years without clinical CAD and with a high 10-year risk (>20%), judged by the PROCAM Score Scheme, have a high probability of subclinical coronary arteriosclerosis and for the occurrence of a cardiac event. Thus, a strict distinction between primary and secondary prevention does not seem to be justified any more.