Acute Ischemic Heart DiseaseDo conventional risk factors predict subclinical coronary artery disease? Results from the Prospective Army Coronary Calcium Project☆,☆☆
Section snippets
Methods
This protocol was approved by the Department of Clinical Investigation of Walter Reed Army Medical Center and funded by the Army Medical Department of the Department of Defense. The methods of the PACC project have been previously published.9 Briefly, all active duty Army personnel, ages 39 to 45 years old, and stationed within the National Capital Area of the Walter Reed Health Care System were recruited at the time of a periodic Army-mandated physical examination. Patients with a history of
Results
The demographic and cardiovascular risk factor characteristics of the 630 participants are shown in Table I.Variable Value (n = 630) Male sex 82% Age (y) 42 ± 2 White race 71.6% College educated 80.9% Cardiac risk factors Total cholesterol (mg/dL) 202 ± 35 LDL cholesterol (mg/dL) 129 ± 33 HDL cholesterol (mg/dL) 52 ± 14 Hypertension 22.9% Tobacco use within 6 months 11.4% Diabetes mellitus 1.7% Family history of coronary artery disease 22.1% Coronary artery calcification
Discussion
The principal finding within this first aim of the PACC Project is the limited relationship between conventional cardiovascular risk prediction and subclinical atherosclerosis detected by EBCT. These data, derived from an unbiased, consecutive, age-homogeneous screening sample, provide important insights into the use of clinical prediction tools in cardiovascular medicine.
The relationship between CAC and cardiovascular risk factors in asymptomatic screening populations has been the subject of
Acknowledgements
We thank Debulon Bell, RN, Dianne Lee, RN, Jon Carrow, RN, Jody Bindeman, RN, and Saroj Bhatarai, MS, for the collection and management of study data and Lisa Pierce for administrative support. The support of the radiology staff is also recognized: Marsha Newby, MRT, Angela Porter, RT, Jeanetta Brooks, RT, and Mrs Patricia Muenzer, RT.
References (28)
- et al.
Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology
J Am Coll Cardiol
(1998) - et al.
Prognostic value of coronary electron-beam computed tomography for coronary heart disease events in asymptomatic populations
Am J Cardiol
(2000) - et al.
Coronary calcium and atherosclerosis by ultrafast computed tomography in asymptomatic men and women: relation to age and risk factors
Am Heart J
(1994) - et al.
Cardiovascular disease risk profiles
Am Heart J
(1991) - et al.
Rationale and design of the Prospective Army Coronary Calcium (PACC) Study: utility of electron beam computed tomography as a screening test for coronary artery disease and as an intervention for risk factor modification among young, asymptomatic, active-duty United States Army Personnel
Am Heart J
(1999) - et al.
Quantification of coronary artery calcium using ultrafast computed tomography
J Am Coll Cardiol
(1990) - et al.
Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study
J Am Coll Cardiol
(1996) - et al.
Lack of association of lipoprotein(a) levels with coronary calcium deposits in asymptomatic postmenopausal women
J Am Coll Cardiol
(2000) - et al.
Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (the Bogalusa Heart Study)
Am J Cardiol
(1992) - et al.
Coronary heart disease in middle-aged Frenchmen: comparisons between Paris Prospective Study, Seven Countries Study, and Pooling Project
Lancet
(1980)
Differences in coronary heart disease in Framingham, Honolulu and Puerto Rico
J Chronic Dis
Prevention Conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: medical office assessment: Writing Group I
Circulation
Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study
Circulation
Prevention Conference V, beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III
Circulation
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2018, American Journal of the Medical SciencesCitation Excerpt :In such a high at-risk population, it is incumbent on policymakers and healthcare providers to design programs and policies that allow clinicians to identify at-risk individuals for risk-stratification and for treatment, so as to achieve the population-level CVD health as espoused by organizations such as the Institute of Medicine (IOM) under Vital Signs.60 Perhaps, CAC screening can be incorporated in CV healthcare in such a high CVD prevalence environment, given that presence of calcification in coronary arteries is a quantifiable marker for coronary atherosclerosis and a measure of plaque burden,46,61-63 CAC is associated with the traditional CVD risk factors,64-71 and CAC improves CV risk prediction when added to traditional risk factors.6,72 Moreover, the expert consensus is that CAC screening is appropriate for individuals at intermediate risk on traditional risk assessment tools1,61,67,73,74 such as those in Central Appalachia where significant proportion of the population has more than 1 CVD risk factor.42
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The opinions or assertions herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.
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Reprint requests: Allen J. Taylor, MD, Cardiology Service, Walter Reed Army Medical Center, Building 2, Room 4A, Washington, DC 20307-5001. E-mail: [email protected]