title: Risk Stratification for Cardiovascular Disease in Women in the Primary Care Setting.
abstract: BACKGROUND
  Traditional risk assessment tools classify the majority of middle-aged women at low risk despite cardiovascular (CV) disease's affecting >50% of women and remaining the leading cause of death. Ultrasound-determined carotid intima-media thickness (CIMT) and/or computed tomographic coronary artery calcium score (CACS) quantify subclinical atherosclerosis and add incremental prognostic value. The aim of this study was to assess the utility of CIMT and CACS to detect subclinical atherosclerosis in younger women.
  
  
  METHODS
  Asymptomatic women aged 50 to 65 years with at least one CV risk factor and low Framingham risk scores were identified prospectively at primary care and cardiology clinics. Mean intimal thickness, plaque on CIMT, and Agatston calcium score for CACS were obtained.
  
  
  RESULTS
  Of 86 women (mean age, 58 ± 4.6 years; mean Framingham risk score, 1.9 ± 1.2; mean low-density lipoprotein cholesterol level, 138.9 ± 37.0 mg/dL), 53 (62%) had high-risk CIMT (51% plaque, 11% CIMT > 75th percentile). In contrast, three women (3.5%) had CACS > 100, all of whom had plaque by CIMT. Of the 58 women with CACS of 0, 32 (55%) had high-risk CIMT (48% plaque, 7% CIMT > 75th percentile).
  
  
  CONCLUSIONS
  In patients referred by their physicians for assessment of CV risk, CIMT in asymptomatic middle-aged women with at least one CV risk factor and low risk by the Framingham risk score identified a large number with advanced subclinical atherosclerosis despite low CACS. Our results suggest that CIMT may be a more sensitive method for CV risk assessment than CACS or traditional risk tools in this population. Further studies are needed to determine if earlier detection would be of clinical benefit.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, University of Arizona College of Medicine, Maricopa Medical Center, Phoenix, Arizona.
authors.forename: Ranjini R
authors.initials: RR
authors.lastname: Roy
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Hurst
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lester
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kendall
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Christy
authors.initials: C
authors.lastname: Baxter
authors.affiliation: College of Medicine, Biostatistics, Division of Health Sciences Research, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Jill
authors.initials: J
authors.lastname: Borovansky
authors.affiliation: Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Julia
authors.initials: J
authors.lastname: Files
authors.affiliation: Department of Radiology, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Prasad
authors.initials: P
authors.lastname: Panse
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, Arizona. Electronic address: wilansky.susan@mayo.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Wilansky
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler / Q000379:methods; D061205:Vascular Calcification / Q000175:diagnosis*
keywords: Calcium score; Carotid ultrasound; Risk; Women