Cardiovascular risk and coronary atherosclerotic plaques detected by multidetector computed tomography:  Framingham and SCORE risk models underestimate coronary atherosclerosis in the symptomatic low-risk Turkish population.
OBJECTIVE
In this study, we investigated the association between cardiovascular (CV) risk factors and coronary atherosclerotic plaque (CAP) burden/subtypes shown by multidetector computed tomography in symptomatic patients free of known coronary artery disease (CAD).


METHODS
In 662 consecutive outpatients (56.9±10.7 years, 50.8% men) without known CAD, 64-slice multidetector computed tomography coronary angiography was performed for detection of CAD. Risk estimation for CV outcomes was assessed using the Systematic Coronary Risk Evaluation (SCORE) and the Framingham Risk Score (FRS). Logistic regression analysis was used to evaluate the association of CV risk factors with the prevalence/extent of CAP.


RESULTS
CAP was detected in 318 (48.0%) individuals. Male sex, older age, hypertension, diabetes mellitus, smoking, and dyslipidemia all increased the likelihood of the presence of CAP in univariate analysis (P<0.001). Older age, male sex, dyslipidemia, and diabetes mellitus independently increased the likelihood of the presence of CAP in multivariate analysis (P<0.005). Multinominal logistic regression analysis showed an association with older age, male sex, dyslipidemia, and smoking for noncalcified plaques; with older age, male sex, diabetes, and dyslipidemia for mixed plaques; and with older age and male sex for calcified plaque. Patients with low FRS and SCORE showed a large number of CAPs (33.8 and 40.4%), although CAP was more prevalent in the high-risk groups (67 and 78%, respectively).


CONCLUSIONS
CV risk stratification using only risk factor-based scores is a weak discriminator of the overall CAP burden in individual patients. Many patients with low FRS or SCORE with substantial CAP might be undertreated or not treated at all.
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Uğur
U
Canpolat
Hikmet
H
Yorgun
Kudret
K
Aytemir
Tuncay
T
Hazrolan
Ergün Barş
EB
Kaya
Ahmet Hakan
AH
Ateş
Muhammed
M
Dural
Kadri Murat
KM
Gürses
Hamza
H
Sunman
Lale
L
Tokgözoğlu
Giray
G
Kabakç
Ali
A
Oto
D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014421:Turkey