Preventive cardiology
Relation of Framingham Risk Score to Subclinical Atherosclerosis Evaluated Across Three Arterial Sites

https://doi.org/10.1016/j.amjcard.2008.05.039Get rights and content

The Framingham risk score (FRS) is widely used in clinical practice to identify subjects at high risk for developing coronary heart disease. However, FRS may not accurately identify subjects at risk. We measured subclinical atherosclerosis in the coronary arteries and aorta with the presence of calcium and in the common carotid artery by intima-media thickness in 498 healthy subjects. The distribution of these subclinical atherosclerosis measures was evaluated across 3 strata of the FRS. Coronary arteries with the presence of calcium, aorta with the presence of calcium, and carotid artery by intima-media thickness were significantly independently associated with FRS. The FRS increased with the number of arterial sites with atherosclerosis; 69% of the subjects categorized in the low risk group (FRS <10%), 95% of the intermediate risk group (FRS 10% to 20%), and 100% of the high risk group (FRS >20%) had ≥1 vascular imaging studies demonstrating subclinical atherosclerosis. In the low risk group, subjects with atherosclerosis had a longer history of lifetime smoking compared with those without atherosclerosis. In conclusion, subclinical atherosclerosis is prominent across the spectrum of FRS. Evaluation of subclinical atherosclerosis in different arterial sites in addition to FRS may be useful in targeting subjects for lifestyle and other interventions.

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Methods

The B-Vitamin Atherosclerosis Intervention Trial is a randomized, double-blind, placebo-controlled, clinical trial designed to test whether B-vitamin supplementation will reduce the progression of early carotid artery atherosclerosis in subjects with elevated fasting homocysteine, but without clinically evident cardiovascular disease. Briefly, potential subjects were prescreened by telephone and met initial screening eligibility if they were at least 40 years of age, postmenopausal (for women),

Results

Baseline data on all 3 atherosclerosis measures were available on 498 of 506 randomized subjects. Table 1 summarizes the demographics and other cardiovascular risk factors of these subjects. The mean ± SD age of the participants was 61 ± 10 years ranging from 40 to 88 years, and 61% were men. The majority of the participants (66%) were non-Hispanic White, 14% were Black, 11% Hispanic, and 9% were Asian; 37% of the subjects had smoked regularly in their lifetime. Overall, the study participants

Discussion

Our data indicate that the CAC, AC, and CIMT are independently associated with the Framingham 10-year CHD risk estimate. We also report that the 10-year FRS increases steadily with increasing number of prevalent atherosclerosis sites in asymptomatic patients.

The FRS is a useful tool for identifying subjects at relatively higher risk of CHD to implement primary prevention interventions. FRS has been shown to be significantly associated with CAC and CIMT in asymptomatic young adults.10, 11

References (29)

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This work is supported by National Institutes of Health grant R01-AG17160, Bethesda, Maryland.

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