Document Detail

Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk.
MedLine Citation:
PMID:  18372487     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients with low-intermediate risk, the use of the Framingham Risk Score (FRS) may not allow accurate prediction of the occurrence of coronary events. OBJECTIVE: To determine whether non-invasive vascular sonographic assessments add value to the FRS for prediction of coronary events. METHODS: Brachial artery flow-mediated dilatation (FMD), carotid intima-media thickness (IMT) and the presence of carotid plaque in 70 male subjects (mean (SD) age 62 (9) years) with a low-intermediate FRS who presented with a recent coronary event were evaluated and compared with those in 35 male controls matched for age (mean age 60 (9) years). RESULTS: Patients with a recent coronary event had a significantly higher FRS than controls. They had a significantly lower FMD (3.56 (2.41)% vs 5.18 (2.69)%, p = 0.003) and significantly higher prevalence of carotid plaque (67% vs 40%, p = 0.008), but there was no significant difference in mean maximum IMT between the two groups (1.01 (0.28) vs 0.96 (0.14) mm, p = 0.32). Multivariate analysis revealed that FMD < or =4.75% was an independent predictor of an acute coronary event. Of the three vascular markers, FMD < or =4.75% and presence of carotid plaque provided the best diagnostic accuracy for a coronary event, with area under the curve (AUC) of 0.70 and 0.64 (p = 0.001 and p = 0.033), respectively, based on receiver operating characteristic curve analysis. Furthermore, incorporating carotid plaque or FMD < or =4.75% into the FRS (AUC = 0.72 and AUC = 0.78) provided incremental benefit in risk stratification over FRS alone (AUC = 0.66) (p = 0.008 and p = 0.007, for comparison of difference in two receiver operating characteristic curves). CONCLUSIONS: Incorporating a measure of FMD or carotid plaque burden with FRS significantly increases the accuracy of predicting coronary events in subjects of low-intermediate risk and hence should be considered as additional investigations to improve coronary risk assessment.
K-K Lau; Y-H Chan; K-H Yiu; S Tam; S-W Li; C-P Lau; H-F Tse
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Postgraduate medical journal     Volume:  84     ISSN:  1469-0756     ISO Abbreviation:  Postgrad Med J     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-28     Completed Date:  2008-06-16     Revised Date:  2009-10-22    
Medline Journal Info:
Nlm Unique ID:  0234135     Medline TA:  Postgrad Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  153-7     Citation Subset:  IM    
Cardiology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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MeSH Terms
Brachial Artery / pathology*
Carotid Arteries / pathology*
Case-Control Studies
Coronary Artery Disease / pathology*
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Tunica Intima / pathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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