Reclassification of Patients for Aggressive Cholesterol Treatment: Additive Value of Multislice Coronary Angiography to the National Cholesterol Education Program Guidelines

Abstract

Background: National Cholesterol Education Program (NCEP) guidelines have been used to define treatment goals in patients with hypercholesterolemia. However, epidemiology-based guidelines are unable to identify all subjects with coronary artery disease for aggressive lipid intervention. Objective: We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment. Methods: Multislice computed tomography was performed in 114 consecutive patients (mean age 57±14 y; 59% male) without known coronary artery disease. Subjects were classified into 3 categories (low-, intermediate-, and high-risk) according to their Framingham risk scores (FRS). Results: Traditional cardiac risk factors were common: hypertension 59%, diabetes 13%, and smoking 22%. On the basis of the FRS, 11% (n = 12/114) of the patients met high-risk criteria requiring aggressive cholesterol reduction. Of those in the low-and intermediate-risk groups, MSCT found coronary plaque in 76% (n = 77/102), with moderate or severe plaque in 38% (n = 39/102), thus reclassifying them in the high-risk category. Use of statin drugs increased from 32% at baseline to 53% (p = 0.002) based on MSCT results; statin dose was increased in 31% of the patients who were already on a statin. The mean low-density lipoprotein cholesterol (LDL-c) decreased from 114 mg/dL to 91 mg/dL after MSCT (p<0.001). Conclusion: Multislice computed tomography reclassifies a high percentage of patients considered to be lowto intermediate-risk into the high-risk category based on their coronary artery lesions. Thus, the rise in MSCT use at present may have a large impact on clinician practice patterns in lipid-lowering therapy.

Impaired aortic distensibility measured by computed tomography is associated with the severity of coronary artery disease

“…Recent studies have showed that FRS has significant limitation in identifying high risk subjects without known CAD [50, 51]. Current findings revealed that CTA provides an accurate measure for vascular function rather than just anatomical studies; Furthermore, in this study aortic distensibility decreased substantially with the severity of coronary atherosclerosis in both genders.…”

“…Clinical guidelines recommend risk management based on the Framingham score [ 45 , 46 ] followed by goal-directed therapy when necessary [ 47 – 49 ] in patients without known prior CAD. Recent studies have showed that FRS has significant limitation in identifying high risk subjects without known CAD [ 50 , 51 ]. Current findings revealed that CTA provides an accurate measure for vascular function rather than just anatomical studies; Furthermore, in this study aortic distensibility decreased substantially with the severity of coronary atherosclerosis in both genders.…”