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

HERNAN A. PEREZ; NESTOR H. GARCIA; J DAVID SPENCE; LUIS J. ARMANDO

ARCHIVES OF MEDICAL SCIENCE

TERMEDIA PUBLISHING HOUSE LTD

Lugar: Poznań; Año: 2016 vol. 12

1734-1922

Introduction: Cardiovascular events (CE) due to atherosclerosis are preventable. Identification of high-risk patients helps to focus resources on those most likely to benefit from expensive therapy. The burden of atherosclerosis is not usually considered for patient risk categorization, even though only a fraction of CE are predicted by Framingham risk factors. Our objective was to assess the incremental value of combining total plaque area (TPA) with the Framingham risk score (FramSc) using post-test probability (Ptp) in order to categorize risk in patients without CE and identify those at high risk and requiring intensive treatment. Material and methods: A descriptive cross-sectional study was performed in the primary care setting in an Argentine population aged 22?90 years without CE. Both FramSc based on body mass index and Ptp-TPA were employed in 2035 patients for risk stratification and the resulting reclassification was compared. Total plaque area was measured with a high-resolution duplex ultrasound scanner. Results: 57% male, 35% hypertensive, 27% hypercholesterolemia, 14% diabetes. 20.1% were low, 28.5% moderate, and 51.5% high risk. When patients were reclassified, 36% of them changed status; 24.1% migrated to a higher and 13.6% to a lower risk level (k index = 0.360, SE k = 0.16). With this reclassification, 19.3% were low, 18.9% moderate and 61.8% high risk. Conclusions: Quantification of Ptp-TPA leads to higher risk estimation than FramSc, suggesting that Ptp-TPA may be more sensitive than FramSc as a screening tool. If our observation is confirmed with a prospective study, this reclassification would improve the long-term benefits related to CE prevention.