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Reclassification of patients for aggressive cholesterol treatment: additive value of multislice coronary angiography to the National Cholesterol Education Program guidelines.

Authors :
Scridon T
Novaro GM
Bush HS
Asher CR
Dandes E
Kabirdas D
Scridon C
Kuo BT
Whiteman M
Shen MY
Source :
Clinical cardiology [Clin Cardiol] 2008 Sep; Vol. 31 (9), pp. 419-23.
Publication Year :
2008

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.<br />Objective: We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment.<br />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).<br />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).<br />Conclusion: Multislice computed tomography reclassifies a high percentage of patients considered to be low- to 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.<br /> (Copyright (c) 2008 Wiley Periodicals, Inc.)

Details

Language :
English
ISSN :
0160-9289
Volume :
31
Issue :
9
Database :
MEDLINE
Journal :
Clinical cardiology
Publication Type :
Academic Journal
Accession number :
18781601
Full Text :
https://doi.org/10.1002/clc.20256