title: Skin cholesterol adds to Framingham risk assessment.
abstract: BACKGROUND
  It has been demonstrated that skin tissue cholesterol (SkinTc) is associated with angiographic disease. Now, we further delineate the relative risk of multivessel disease (>50% stenosis in at least two vessels) in the conjoint presence of high SkinTc and high traditional risk burden.
  
  
  METHODS
  Patients scheduled for angiography (N = 649) had SkinTc measured immediately prior to the procedure. Patients were classified according to the presence of high (>110) SkinTc and high (>10) Framingham global risk scores. Multivariable logistic regression models were used to estimate relative risk of multivessel disease for patients with isolated high skin tissue cholesterol, isolated high Framingham risk or conjoint high skin tissue cholesterol and high Framingham risk (each compared to neither factor elevated).
  
  
  RESULTS
  The mean age was 63 +/- 12 years and 33% (n = 214) were women. Thirty seven percent (n = 237) had angiographically determined multivessel disease. Patients with isolated high SkinTc showed a relative risk of multivessel disease of 1.6 (95% CI = 1.0-2.4), while patients with isolated high Framingham risk had an odds ratio of 1.8 (CI = 1.0-3.4). However, when both scores were elevated, risk of multivessel disease was increased 4.3 times (CI = 2.6-7.2) compared to neither elevated.
  
  
  CONCLUSIONS
  We see an independent, additive risk of concurrent multivessel disease when Framingham risk and skin cholesterol are both elevated. Skin tissue cholesterol may have value in further stratifying subjects with Framingham scores >10.
authors.affiliation: Department of Medicine and Experimental Therapeutics, The University of Pennsylvania, Philadelphia, PA 19104, USA. dennis.sprecher@uphs.upenn.edu
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Sprecher
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Pearce
mesh_terms: D000368:Aged; D002784:Cholesterol / Q000378:metabolism*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012306:Risk; D018570:Risk Assessment; D012867:Skin / Q000378:metabolism*
chemical_list: D002784:Cholesterol