Abstract 2491: Risk Factors in First Presentation Acute Coronary Syndromes (ACS): How do we Move From Population to Individualized Risk Prediction?
Background: Patients with acute coronary syndromes (ACS) have a poor short and long-term prognosis. Identifying and treating persons with classic coronary risk factors represents the best opportunity to prevent ACS.
Hypothesis: We sought to examine the presence of coronary risk factors in contemporary patients presenting with an ACS and no known CAD.
Methods: A prospective cohort study was conducted in 3171 consecutive patients admitted to the University of Michigan between 1999 and 2004 with the diagnosis of ACS. Of these, 941 patients (30%) had a first ACS and no history of CAD. Coronary risk factors were defined as: age >65 years, LDL >130, low HDL (<40 in men, <50 in women), smoking (current or former), diabetes, hypertension, renal failure, family history of CAD and dyslipidemia (diagnosed hyperlipidemia or patients on therapy).
Results: Patients were divided into groups by number and combinations of risk factors (1–7)(see figure⇓). Only 2.5% of patients had no coronary risk factors. The most prevalent risk factors were smoking (58.6%), hypertension (56%), low HDL (51%) and a family history of CAD (48%).
Conclusion: In this cohort, 30% of the patients presenting for ACS had no prior knowledge of their underlying CAD. However, of these patients 97.5% had at least 1 known risk factor, and 90% had 2 or more risk factors. Current population-based screening efforts must be improved to allow more effective prevention strategies and more individualized risk prediction.