CLINICAL RESEARCH: IMAGING
Detection of High-Risk Young Adults and Women by Coronary Calcium and National Cholesterol Education Program Panel III Guidelines
Khurram Nasir, MD, MPH*, ,
Erin D. Michos, MD,
Roger S. Blumenthal, MD and
Paolo Raggi, MD ,*
* Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
The Ciccarone Preventive Cardiology Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
Section of Cardiology, Tulane University, New Orleans, Louisiana
Manuscript received May 10, 2005;
revised manuscript received July 1, 2005,
accepted July 19, 2005.
* Reprint requests and correspondence: Dr. Paolo Raggi, 1430 Tulane Avenue, SL-48, New Orleans, Louisiana 70112 (Email: praggi{at}excite.com).
OBJECTIVES: The purpose of this study was to investigate the classification of cardiovascular risk in young individuals and women according to the National Cholesterol Education Program (NCEP) guidelines across a continuum of coronary calcium scores (CCS).
BACKGROUND: Current NCEP guidelines might underestimate cardiovascular risk in young individuals and women.
METHODS: The study population consisted of 1,611 asymptomatic individuals (67% men, mean age: 53 ± 10 years) who presented to a single electron beam tomography facility for coronary artery calcium screening. Participants were categorized into low-risk (n = 738, 46%), intermediate-risk (n = 583, 36%), moderately high-risk (n = 263, 16%), and high-risk (n = 27, 2%) according to the NCEP Panel III guidelines.
RESULTS: Absence of calcium, CCS of 0 to 99 (mild), 100 to 399 (moderate), and  400 (severe), was observed in 572 (35%), 707 (44%), 192 (12%), and 140 (9%) of the patients, respectively. A high CCS percentile (75th percentile) was present in 426 (26%) individuals. Overall, 59% and 78% of participants with CCS 400 and CCS 75th percentile were not identified as high risk and candidates for pharmacotherapy on the basis of NCEP categories. Furthermore, women as well as young individuals were less likely to be considered candidates for pharmacotherapy compared with men and older individuals in each CCS category.
CONCLUSIONS: The NCEP guidelines seem to underestimate cardiovascular risk in young asymptomatic individuals and women. For these individuals, assessment of plaque burden might provide incremental value to global risk assessment.
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Abbreviations and Acronyms
| | CCS = coronary calcium score | | CHD = coronary heart disease | | EBT = electron beam tomography | | HDL = high-density lipoprotein | | LDL = low-density lipoprotein | | NCEP = National Cholesterol Education Program |
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