Abstract 1648: Framingham Risk Score is Poorly Associated With Subclinical Carotid Atherosclerosis: Results From Firefighter Heart Disease Prevention Project
BACKGROUND: Framingham risk scores (FRS) are used to estimate the 10-year coronary heart disease (CHD) risk in individuals. Non-invasive assessment of subclinical atherosclerosis by means of carotid intima media thickness (cIMT) could improve patients’ risk stratification even though it is not part of current guidelines.
OBJECTIVE: We examined the distribution of FRS scores of cIMT positive and negative individuals. We hypothesize that FRS underestimates the early carotid atherosclerotic risk in firefighters.
METHODS: We studied 159 male firefighters (age, 47±5 yrs) without known coronary, peripheral, or cerebral vascular disease. Each participant underwent clinical and serologic risk factor screening and cIMT with high resolution ultrasound. Abnormal cIMT was defined as intimal thicking ≥0.9 mm
RESULTS: Out of 159 firefighters 30 (19%) had evidence of early atherosclerosis by cIMT. Of these 30 positive cIMT firefighters 19 (63%) had low risk FRS (0 –10%), 11 (30%) had moderate risk FRS (10 –20%) and 2 (7%) had high risk FRS (>20). Between high risk and low to moderate risk groups while this represents a stellar false negative rate is 93% even though excellent false positive rate of 0%.
CONCLUSIONS: In this age-homogeneous, low-risk screening cohort, FRS underestimated the presence of premature, subclinical carotid atherosclerosis. In our observations, a large number of firefighters with low to moderate Framingham risk scores who are not currently treated to the maximal goals have already have evidence of early carotid atherosclerosis.