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Reclassification of patients for aggressive cholesterol treatment: additive value of multislice coronary angiography to the National Cholesterol Education Program guidelines.
- 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.)
- Subjects :
- Aged
Coronary Artery Disease complications
Coronary Artery Disease diagnostic imaging
Female
Humans
Hypercholesterolemia classification
Hypercholesterolemia complications
Hypercholesterolemia diagnostic imaging
Male
Middle Aged
Practice Guidelines as Topic
Risk Factors
Anticholesteremic Agents therapeutic use
Coronary Angiography
Hypercholesterolemia drug therapy
Tomography, X-Ray Computed
Subjects
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