Women with a low Framingham risk score and a family history of premature coronary heart disease have a high prevalence of subclinical coronary atherosclerosis.
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.
Michos
Erin D
ED
Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Vasamreddy
Chandrasekhar R
CR
Becker
Diane M
DM
Yanek
Lisa R
LR
Moy
Taryn F
TF
Fishman
Elliot K
EK
Becker
Lewis C
LC
Blumenthal
Roger S
RS
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