Risk assessment is assuming an increasing role for identification of high-risk
persons for intensive medical intervention to reduce risk for coronary heart
disease (CHD).
Of particular importance is the
need to identify those persons with CHD risk equivalents who can be managed with
the same intensity as patients with established CHD.
For example, the National Cholesterol Education Program (NCEP) recently
classified diabetes as a CHD risk equivalent. The NCEP also recommended use of
Framingham risk scoring in persons with multiple (2+) risk factors to uncover
others without diabetes who have CHD risk equivalents.
One limitation of Framingham risk
scoring, however, is that age
becomes the dominant risk factor after age 50. Age is a surrogate for
coronary atherosclerotic plaque burden, which is the true risk factor. However,
for individuals, coronary plaque burden can vary greatly at any given age.
An elderly person may have clean arteries and would not be at risk of heart
attack but a young 35 year old person may have clogged arteries like a 65
year old and hence be at high risk of a heart attack.
For this reason, since coronary
plaque burden could be measured accurately with noninvasive techniques, the
degree of plaque burden could be used to replace age as a risk factor in
Framingham scoring for risk prediction.
