Greater Los Angeles VA Medical Center, UCLA School of Medicine, Los Angeles, CA, USA.
Am J Cardiol. 2011 Mar 15;107(6):799-804. doi: 10.1016/j.amjcard.2010.10.066. Epub 2011 Jan 19.
A risk-management approach based on the Framingham risk score (FRS), although useful in preventing future coronary artery disease (CAD) events, is unable to identify a considerable portion of patients with CAD who need aggressive medical management. Coronary artery calcium (CAC), an anatomic marker of atherosclerosis, correlates well with presence and extent of CAD. This study investigated mortality risk associated with CAC score and FRS in subjects classified as "low risk" versus "high risk" based on FRS. In total 730 veterans without known CAD (61 ± 10 years old, 12.8% women) underwent measurement of their FRS and CAC. Subjects were classified as "discordant low risk" (DLR) if their FRS was <10% and CAC score was ≥ 100 (n = 108, 14.8%) or "discordant high risk" (DHR) if their FRS was ≥ 20% and CAC score was 0 (n = 104, 14.2%). Survival analysis was used to compare mortality rates associated with FRS and CAC in DLR versus DHR subjects. Mortality rate during the mean 48-month follow-up was 7.3% (n = 53) including 18.5% (n = 20) in the DLR group and 7.7% (n = 8) in the DHR group, respectively. Adjusted relative risks of mortality were 5.46 (95% confidence interval [CI] 2.44 to 12.20, p = 0.0001) in subjects with CAC score ≥ 100 compared to CAC score 0 and 1.35 (95% CI 1.01 to 4.32, p = 0.04) in subjects with FRS ≥ 20% compared to FRS <10%. Adjusted relative risk of mortality was 3.6 (95% CI 1.57 to 8.34, p = 0.003) for DLR compared to DHR. Areas under the receiver operator curve to predict mortality were 0.72 for FRS, 0.82 for CAC score, and 0.92 for the combination. In conclusion, the prognostic value of CAC to predict future mortality is superior to the FRS. Addition of CAC score to FRS significantly improves the identification and prognostication of patients without known CAD.
一种基于弗雷明汉风险评分（FRS）的风险管理方法，尽管在预防未来的冠状动脉疾病（CAD）事件方面很有用，但无法识别出需要积极医疗管理的相当一部分 CAD 患者。冠状动脉钙（CAC）是动脉粥样硬化的解剖标志物，与 CAD 的存在和程度密切相关。本研究调查了基于 FRS 分类为“低风险”与“高风险”的受试者中 CAC 评分和 FRS 相关的死亡率风险。共有 730 名无已知 CAD 的退伍军人（61 ± 10 岁，12.8%为女性）接受了 FRS 和 CAC 的测量。如果他们的 FRS<10%且 CAC 评分≥100，则将他们分类为“不一致低风险”（DLR）（n=108，14.8%），如果他们的 FRS≥20%且 CAC 评分为 0，则将他们分类为“不一致高风险”（DHR）（n=104，14.2%）。使用生存分析比较 DLR 与 DHR 受试者中 FRS 和 CAC 相关的死亡率。在平均 48 个月的随访期间，死亡率为 7.3%（n=53），其中 DLR 组为 18.5%（n=20），DHR 组为 7.7%（n=8）。与 CAC 评分 0 相比，CAC 评分≥100 的受试者死亡的调整相对风险为 5.46（95%置信区间[CI]2.44 至 12.20，p=0.0001），与 FRS<10%相比，FRS≥20%的受试者死亡的调整相对风险为 1.35（95%CI1.01 至 4.32，p=0.04）。与 DHR 相比，DLR 的死亡调整相对风险为 3.6（95%CI1.57 至 8.34，p=0.003）。FRS 预测死亡率的接收者操作特征曲线下面积为 0.72，CAC 评分的面积为 0.82，组合的面积为 0.92。总之，CAC 预测未来死亡率的预后价值优于 FRS。将 CAC 评分添加到 FRS 中可显著提高对无已知 CAD 患者的识别和预后判断。
