Women with a low Framingham risk score and a family history of premature coronary heart disease have a high prevalence of subclinical coronary atherosclerosis

Michos, Erin D.; Vasamreddy, Chandrasekhar R.; Becker, Diane M.; Yanek, Lisa R.; Moy, Taryn F.; Fishman, Elliot K.; Becker, Lewis C.; Blumenthal, Roger S.

doi:10.1016/j.ahj.2005.02.037

« Previous Next »American Heart Journal
Volume 150, Issue 6 , Pages 1276-1281, December 2005

Women with a low Framingham risk score and a family history of premature coronary heart disease have a high prevalence of subclinical coronary atherosclerosis

Erin D. Michos, MD
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
Chandrasekhar R. Vasamreddy, MD
- Division of Internal Medicine, the Center for Health Promotion, Johns Hopkins Medical Institutions, Baltimore, Md
Diane M. Becker, MPH, ScD
- Division of Internal Medicine, the Center for Health Promotion, Johns Hopkins Medical Institutions, Baltimore, Md
Lisa R. Yanek, MPH
- Division of Internal Medicine, the Center for Health Promotion, Johns Hopkins Medical Institutions, Baltimore, Md
Taryn F. Moy, MS
- Division of Internal Medicine, the Center for Health Promotion, Johns Hopkins Medical Institutions, Baltimore, Md
Elliot K. Fishman, MD
- Division of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md
Lewis C. Becker, MD
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
Roger S. Blumenthal, MD, FACC
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
- Reprint requests: Roger S. Blumenthal, MD, Ciccarone Preventive Cardiology Center, Blalock 524 C-Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287.

Received 13 September 2004; accepted 14 February 2005.

Background

The Framingham risk estimation (FRE) serves as the basis for identifying which asymptomatic adults should be treated with aspirin and lipid-lowering therapy in primary prevention. However, the FRE generally yields low estimates of 10-year “hard” coronary heart disease (CHD) event risk with few women (<70 years) qualifying for preventive pharmacologic therapy despite relatively high lifetime risk. We postulated that traditional risk factor assessment might fail to identify a sizeable portion of women with a sibling history for premature CHD as having advanced subclinical atherosclerosis.

Methods

We studied 102 asymptomatic women (mean age 51 ± 7 years) who were the sisters of a proband hospitalized with documented premature CHD. Participants underwent risk factor assessment and multidetector computed tomography for coronary artery calcium (CAC) scoring. Based on FRE prediction of 10-year risk for hard CHD events, participants were classified as low risk (<10%) (n = 100), intermediate risk (10%-20%) (n = 2), or high risk (>20%) (n = 0). Significant subclinical atherosclerosis was defined as age-sex adjusted >75th percentile CAC scores.

Results

Ninety-eight percent were at low risk (mean FRE of only 2% ± 2%). However, 40% had detectable CAC, 12% had CAC >100, and 6% had CAC ≥400. Based on CAC score percentiles, 32% had significant subclinical atherosclerosis and 17% ranked above the 90th percentile.

Conclusion

Among women classified as low risk by FRE, a third had significant subclinical atherosclerosis. Sisters of probands with premature CHD appear to be a high-risk group and may warrant noninvasive screening for subclinical atherosclerosis to appropriately target individuals for more aggressive primary prevention therapy than what is currently recommended.