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Low Framingham Score May Underestimate Coronary Artery Disease Risk Compared With the Presence of Calcium

23 October 2012
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April 22, 2010 — Almost two thirds of women and one fourth of men with substantial atherosclerosis will be missed if subjects are excluded from further screening because they are in the Framingham low-risk category, according to a report published in the May issue of the American Journal of Roentgenology."Many coronary events occur in patients without warning, and the need for an effective screening program has been recognized for many years. Historically, the Framingham risk score has been the dominant method of risk stratification in the United States," write study coauthors Kevin M. Johnson, MD, from the Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, and David A. Dowe, from Atlantic Medical Imaging, Galloway, New Jersey.

In participants with a segment plaque score of 4 or higher, the presence of any calcium was 98% sensitive in men and 97% sensitive in women. In contrast, a Framingham risk score of 10% or higher was only 74% sensitive in men and 36% sensitive in women. The negative likelihood ratio for the presence of calcium was 0.04 in men and women, whereas the negative likelihood ratio for a Framingham risk score of 10% or lower was 0.38 in men and 0.71 in women.

"As our study suggests, the presence of coronary artery calcium detects more patients with coronary atherosclerosis than does the Framingham risk assessment score," Dr. Johnson noted in a written release. "If the Framingham risk score is used as the 'gatekeeper' in a screening program for coronary atherosclerosis and the low-risk patients are dismissed from further study, about two thirds of women and a quarter of men with substantial atherosclerosis will be missed."

Read 1780 times Last modified on Tuesday, 04 December 2012 11:58

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