Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification

Area of Science:

• Cardiology
• Vascular Medicine
• Preventive Medicine

Background:

• Cardiovascular events (CE) stemming from atherosclerosis are preventable.
• Identifying high-risk individuals is crucial for targeted, effective interventions.
• Current risk factors, like the Framingham risk score (FramSc), do not fully account for atherosclerosis in risk prediction.

Purpose of the Study:

• To evaluate the added value of combining total plaque area (TPA) with FramSc for risk stratification.
• To assess the post-test probability of TPA (Ptp-TPA) in categorizing risk for patients without existing CE.
• To identify patients requiring intensive treatment for atherosclerosis.

Main Methods:

• A cross-sectional study involving 2035 patients aged 22-90 without CE in primary care.
• Risk stratification using both FramSc (based on BMI) and Ptp-TPA.
• Comparison of patient reclassification between the two methods.
• Measurement of TPA using high-resolution duplex ultrasound.

Main Results:

• The study population comprised 57% males, with 35% hypertensive, 27% hypercholesterolemic, and 14% diabetic.
• Initial risk stratification showed 20.1% low, 28.5% moderate, and 51.5% high risk.
• Reclassification altered the status of 36% of patients (24.1% to higher risk, 13.6% to lower risk), with a κ index of 0.360 (p < 0.05).
• Post-reclassification, risk distribution was 19.3% low, 18.9% moderate, and 61.8% high risk.

Conclusions:

• Quantification of Ptp-TPA results in higher cardiovascular risk estimation compared to FramSc.
• Ptp-TPA demonstrates potential as a more sensitive screening tool for atherosclerosis.
• Prospective studies are needed to confirm these findings and their impact on long-term CE prevention benefits.