Circulation. 2001;104:1863-1867
doi: 10.1161/hc4201.097189
doi: 10.1161/hc4201.097189
(Circulation. 2001;104:1863.)
© 2001 American Heart Association, Inc.
Current Perspective |
Improving Coronary Heart Disease Risk Assessment in Asymptomatic People
Role of Traditional Risk Factors and Noninvasive Cardiovascular Tests
From the Departments of Preventive Medicine and Medicine, Northwestern University Medical School, Chicago, Ill (P.G.); the Division of Cardiology, Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill (S.C.S.); and the Departments of Clinical Nutrition and Internal Medicine, University of Texas Southwestern Medical Center, Dallas (S.M.G.).
Correspondence to Philip Greenland, MD, Department of Preventive Medicine, Northwestern University Medical School, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611. E-mail p-greenland@northwestern.edu
Key Words: coronary disease • prevention • prognosis • risk factors
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Introduction |
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At least 25% of coronary patients have sudden death or nonfatal myocardial infarction without prior symptoms.1 Therefore, the search for coronary patients with subclinical disease who could potentially benefit from intensive primary prevention efforts is critically important. The American Heart Association’s (AHA) Prevention V Conference, "Beyond Secondary Prevention: Identifying the High Risk Patient for Primary Prevention," addressed ways to identify more patients who are asymptomatic and clinically free of coronary heart disease (CHD) but at sufficiently high risk for a future coronary event to justify more intensive risk reduction efforts.2 In this report, we amplify on key findings and recommendations of the AHA Prevention V conference, highlight new research since the conference, and propose an approach to the use of office-based testing and additional noninvasive procedures in selected patients to better define their coronary event risk. The recommendations are concordant with the recently released approach to risk assessment and management from the third report of the Adult Treatment Panel of the National Cholesterol Education Program (ATP-III).3
Enthusiasm for primary prevention and risk assessment in asymptomatic people has been spurred by recent advances in prevention research. Lipid-lowering trials demonstrated that primary prevention of coronary events is feasible, evidenced by the West of Scotland Coronary Primary Prevention Study (WOSCOPS) trial4 of hypercholesterolemic men and by the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) trial5 in average or typical risk men and women with only moderate lipid abnormalities. Aspirin6 or ACE inhibitors7 can also reduce risk in selected asymptomatic, high-risk people. Emerging coronary
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P. W. F. Wilson, S. C. Smith Jr, R. S. Blumenthal, G. L. Burke, and N. D. Wong Task force #4--how do we select patients for atherosclerosis imaging? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1898 - 1906. [Full Text] [PDF]
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D. B. Mark, L. J. Shaw, M. S. Lauer, P. G. O'Malley, and P. Heidenreich Task force #5--is atherosclerosis imaging cost effective? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1906 - 1917. [Full Text] [PDF]
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G. T. Kondos, J. A. Hoff, A. Sevrukov, M. L. Daviglus, D. B. Garside, S. S. Devries, E. V. Chomka, and K. Liu Electron-Beam Tomography Coronary Artery Calcium and Cardiac Events: A 37-Month Follow-Up of 5635 Initially Asymptomatic Low- to Intermediate-Risk Adults Circulation, May 27, 2003; 107(20): 2571 - 2576. [Abstract] [Full Text] [PDF]
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P. G. O'Malley, I. M. Feuerstein, and A. J. Taylor Impact of Electron Beam Tomography, With or Without Case Management, on Motivation, Behavioral Change, and Cardiovascular Risk Profile: A Randomized Controlled Trial JAMA, May 7, 2003; 289(17): 2215 - 2223. [Abstract] [Full Text] [PDF]
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P. Greenland Improving Risk of Coronary Heart Disease: Can a Picture Make the Difference? JAMA, May 7, 2003; 289(17): 2270 - 2272. [Full Text] [PDF]
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M. J. Budoff Point: Diabetic Patients and Coronary Calcium: Risk stratification, compliance, and plaque progression Diabetes Care, February 1, 2003; 26(2): 541 - 542. [Full Text] [PDF]
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A. B. Newman, B. L. Naydeck, K. Sutton-Tyrrell, D. Edmundowicz, D. O'Leary, R. Kronmal, G. L. Burke, and L. H. Kuller Relationship Between Coronary Artery Calcification and Other Measures of Subclinical Cardiovascular Disease in Older Adults Arterioscler Thromb Vasc Biol, October 1, 2002; 22(10): 1674 - 1679. [Abstract] [Full Text] [PDF]
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S. K. Weinberg, D. Ackman, S. Glied, J. P. L. Nunes, J. W. Hurst, J. E. Ehrlich, J. A. Rumberger, A. G. Wasserman, M. Rosenthal, R. G. Frank, et al. Direct-to-Consumer Marketing N. Engl. J. Med., June 20, 2002; 346(25): 2010 - 2013. [Full Text] [PDF]
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