title: Women with a low Framingham risk score and a family history of premature coronary heart disease have a high prevalence of subclinical coronary atherosclerosis.
abstract: 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 > or = 400. Based on CAC score percentiles, 32% had significant subclinical atherosclerosis and 17% ranked above the 90th percentile.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.forename: Chandrasekhar R
authors.initials: CR
authors.lastname: Vasamreddy
authors.forename: Diane M
authors.initials: DM
authors.lastname: Becker
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Yanek
authors.forename: Taryn F
authors.initials: TF
authors.lastname: Moy
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Lewis C
authors.initials: LC
authors.lastname: Becker
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000235:genetics*; D005190:Family; D005260:Female; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012959:Socioeconomic Factors