Risk Stratification for Cardiovascular Disease in Women in the Primary Care Setting

Ranjini R. Roy, R. Todd Hurst, Steven Jay Lester, Christopher Kendall, Christy Baxter, Qing Wu, Jill Borovansky, Julia Files, Prasad Panse, Susan Wilansky

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Traditional risk assessment tools classify the majority of middle-aged women at low risk despite cardiovascular (CV) disease's affecting >50% of women and remaining the leading cause of death. Ultrasound-determined carotid intima-media thickness (CIMT) and/or computed tomographic coronary artery calcium score (CACS) quantify subclinical atherosclerosis and add incremental prognostic value. The aim of this study was to assess the utility of CIMT and CACS to detect subclinical atherosclerosis in younger women. Methods Asymptomatic women aged 50 to 65 years with at least one CV risk factor and low Framingham risk scores were identified prospectively at primary care and cardiology clinics. Mean intimal thickness, plaque on CIMT, and Agatston calcium score for CACS were obtained. Results Of 86 women (mean age, 58 ± 4.6 years; mean Framingham risk score, 1.9 ± 1.2; mean low-density lipoprotein cholesterol level, 138.9 ± 37.0 mg/dL), 53 (62%) had high-risk CIMT (51% plaque, 11% CIMT > 75th percentile). In contrast, three women (3.5%) had CACS > 100, all of whom had plaque by CIMT. Of the 58 women with CACS of 0, 32 (55%) had high-risk CIMT (48% plaque, 7% CIMT > 75th percentile). Conclusions In patients referred by their physicians for assessment of CV risk, CIMT in asymptomatic middle-aged women with at least one CV risk factor and low risk by the Framingham risk score identified a large number with advanced subclinical atherosclerosis despite low CACS. Our results suggest that CIMT may be a more sensitive method for CV risk assessment than CACS or traditional risk tools in this population. Further studies are needed to determine if earlier detection would be of clinical benefit.

Original languageEnglish (US)
Pages (from-to)1232-1239
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume28
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Carotid Intima-Media Thickness
Primary Health Care
Cardiovascular Diseases
Coronary Vessels
Calcium
Atherosclerosis
Tunica Intima
Cardiology
LDL Cholesterol
Cause of Death
Physicians

Keywords

  • Calcium score
  • Carotid ultrasound
  • Risk
  • Women

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Risk Stratification for Cardiovascular Disease in Women in the Primary Care Setting. / Roy, Ranjini R.; Hurst, R. Todd; Lester, Steven Jay; Kendall, Christopher; Baxter, Christy; Wu, Qing; Borovansky, Jill; Files, Julia; Panse, Prasad; Wilansky, Susan.

In: Journal of the American Society of Echocardiography, Vol. 28, No. 10, 01.10.2015, p. 1232-1239.

Research output: Contribution to journalArticle

Roy, RR, Hurst, RT, Lester, SJ, Kendall, C, Baxter, C, Wu, Q, Borovansky, J, Files, J, Panse, P & Wilansky, S 2015, 'Risk Stratification for Cardiovascular Disease in Women in the Primary Care Setting', Journal of the American Society of Echocardiography, vol. 28, no. 10, pp. 1232-1239. https://doi.org/10.1016/j.echo.2015.06.015
Roy, Ranjini R. ; Hurst, R. Todd ; Lester, Steven Jay ; Kendall, Christopher ; Baxter, Christy ; Wu, Qing ; Borovansky, Jill ; Files, Julia ; Panse, Prasad ; Wilansky, Susan. / Risk Stratification for Cardiovascular Disease in Women in the Primary Care Setting. In: Journal of the American Society of Echocardiography. 2015 ; Vol. 28, No. 10. pp. 1232-1239.
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abstract = "Background Traditional risk assessment tools classify the majority of middle-aged women at low risk despite cardiovascular (CV) disease's affecting >50{\%} of women and remaining the leading cause of death. Ultrasound-determined carotid intima-media thickness (CIMT) and/or computed tomographic coronary artery calcium score (CACS) quantify subclinical atherosclerosis and add incremental prognostic value. The aim of this study was to assess the utility of CIMT and CACS to detect subclinical atherosclerosis in younger women. Methods Asymptomatic women aged 50 to 65 years with at least one CV risk factor and low Framingham risk scores were identified prospectively at primary care and cardiology clinics. Mean intimal thickness, plaque on CIMT, and Agatston calcium score for CACS were obtained. Results Of 86 women (mean age, 58 ± 4.6 years; mean Framingham risk score, 1.9 ± 1.2; mean low-density lipoprotein cholesterol level, 138.9 ± 37.0 mg/dL), 53 (62{\%}) had high-risk CIMT (51{\%} plaque, 11{\%} CIMT > 75th percentile). In contrast, three women (3.5{\%}) had CACS > 100, all of whom had plaque by CIMT. Of the 58 women with CACS of 0, 32 (55{\%}) had high-risk CIMT (48{\%} plaque, 7{\%} CIMT > 75th percentile). Conclusions In patients referred by their physicians for assessment of CV risk, CIMT in asymptomatic middle-aged women with at least one CV risk factor and low risk by the Framingham risk score identified a large number with advanced subclinical atherosclerosis despite low CACS. Our results suggest that CIMT may be a more sensitive method for CV risk assessment than CACS or traditional risk tools in this population. Further studies are needed to determine if earlier detection would be of clinical benefit.",
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AU - Wu, Qing

AU - Borovansky, Jill

AU - Files, Julia

AU - Panse, Prasad

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N2 - Background Traditional risk assessment tools classify the majority of middle-aged women at low risk despite cardiovascular (CV) disease's affecting >50% of women and remaining the leading cause of death. Ultrasound-determined carotid intima-media thickness (CIMT) and/or computed tomographic coronary artery calcium score (CACS) quantify subclinical atherosclerosis and add incremental prognostic value. The aim of this study was to assess the utility of CIMT and CACS to detect subclinical atherosclerosis in younger women. Methods Asymptomatic women aged 50 to 65 years with at least one CV risk factor and low Framingham risk scores were identified prospectively at primary care and cardiology clinics. Mean intimal thickness, plaque on CIMT, and Agatston calcium score for CACS were obtained. Results Of 86 women (mean age, 58 ± 4.6 years; mean Framingham risk score, 1.9 ± 1.2; mean low-density lipoprotein cholesterol level, 138.9 ± 37.0 mg/dL), 53 (62%) had high-risk CIMT (51% plaque, 11% CIMT > 75th percentile). In contrast, three women (3.5%) had CACS > 100, all of whom had plaque by CIMT. Of the 58 women with CACS of 0, 32 (55%) had high-risk CIMT (48% plaque, 7% CIMT > 75th percentile). Conclusions In patients referred by their physicians for assessment of CV risk, CIMT in asymptomatic middle-aged women with at least one CV risk factor and low risk by the Framingham risk score identified a large number with advanced subclinical atherosclerosis despite low CACS. Our results suggest that CIMT may be a more sensitive method for CV risk assessment than CACS or traditional risk tools in this population. Further studies are needed to determine if earlier detection would be of clinical benefit.

AB - Background Traditional risk assessment tools classify the majority of middle-aged women at low risk despite cardiovascular (CV) disease's affecting >50% of women and remaining the leading cause of death. Ultrasound-determined carotid intima-media thickness (CIMT) and/or computed tomographic coronary artery calcium score (CACS) quantify subclinical atherosclerosis and add incremental prognostic value. The aim of this study was to assess the utility of CIMT and CACS to detect subclinical atherosclerosis in younger women. Methods Asymptomatic women aged 50 to 65 years with at least one CV risk factor and low Framingham risk scores were identified prospectively at primary care and cardiology clinics. Mean intimal thickness, plaque on CIMT, and Agatston calcium score for CACS were obtained. Results Of 86 women (mean age, 58 ± 4.6 years; mean Framingham risk score, 1.9 ± 1.2; mean low-density lipoprotein cholesterol level, 138.9 ± 37.0 mg/dL), 53 (62%) had high-risk CIMT (51% plaque, 11% CIMT > 75th percentile). In contrast, three women (3.5%) had CACS > 100, all of whom had plaque by CIMT. Of the 58 women with CACS of 0, 32 (55%) had high-risk CIMT (48% plaque, 7% CIMT > 75th percentile). Conclusions In patients referred by their physicians for assessment of CV risk, CIMT in asymptomatic middle-aged women with at least one CV risk factor and low risk by the Framingham risk score identified a large number with advanced subclinical atherosclerosis despite low CACS. Our results suggest that CIMT may be a more sensitive method for CV risk assessment than CACS or traditional risk tools in this population. Further studies are needed to determine if earlier detection would be of clinical benefit.

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