Michos Erin D, Nasir Khurram, Braunstein Joel B, Rumberger John A, Budoff Matthew J, Post Wendy S, Blumenthal Roger S
Ciccarone Preventive Cardiology Center, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Atherosclerosis. 2006 Jan;184(1):201-6. doi: 10.1016/j.atherosclerosis.2005.04.004.
Coronary heart disease (CHD) is the leading cause of death among American women. Currently, global risk assessment derived by Framingham risk equation (FRE) is used to identify women at increased risk for CHD. Electron-beam computed tomography (EBCT) derived coronary artery calcium (CAC) scores are validated markers for future CHD events among asymptomatic individuals. However, the adequacy of FRE for identifying asymptomatic women with CAC is unknown.
We studied 2447 consecutive non-diabetic asymptomatic females (55 +/- 10 years). Based upon FRE, 90% were classified as low-risk (FRE < or = 9% 10-year risk of hard CHD events), 10% intermediate-risk (10-20%), and none were considered as high-risk (> 20%). Coronary artery calcium was present in 33%, whereas CAC > or = 100 and CAC > or = 400 were seen in 10 and 3% of women, respectively. Overall, 20% of women had age-gender derived > or = 75th percentile CAC. According to FRE, the majority (84%) of women with significant CAC > or = 75th percentile were classified as low-risk. Approximately half (45%) of low-risk women with > or = 2 CHD risk factors and a family history of premature CHD had significant CAC.
Framingham risk equation frequently classifies women as being low-risk, even in the presence of significant CAC. Determination of CAC may provide incremental value to FRE in identifying asymptomatic women who will benefit from targeted preventative measures.
冠心病（CHD）是美国女性死亡的主要原因。目前，通过弗雷明汉风险方程（FRE）得出的全球风险评估用于识别冠心病风险增加的女性。电子束计算机断层扫描（EBCT）得出的冠状动脉钙化（CAC）评分是无症状个体未来发生冠心病事件的有效标志物。然而，FRE用于识别有CAC的无症状女性的充分性尚不清楚。
我们研究了2447名连续的非糖尿病无症状女性（55±10岁）。根据FRE，90%被分类为低风险（FRE≤9%，10年发生严重冠心病事件的风险），10%为中度风险（10 - 20%），无人被视为高风险（>20%）。33%的女性存在冠状动脉钙化，而分别有10%和3%的女性CAC≥100和CAC≥400。总体而言，20%的女性的CAC高于年龄 - 性别相关的第75百分位数。根据FRE，大多数（84%）CAC高于第75百分位数的女性被分类为低风险。约一半（45%）有≥2个冠心病风险因素且有早发冠心病家族史的低风险女性有显著的CAC。
即使存在显著的CAC，弗雷明汉风险方程也经常将女性分类为低风险。在识别将从有针对性的预防措施中获益的无症状女性方面，确定CAC可能为FRE提供额外价值。
