Should Coronary Calcium Screening Be Used in Cardiovascular Prevention Strategies?  

Oleh:

Bonow, Robert O.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 361 no. 10 (Sep. 2009), page 990-997.
Topik: Coronary; Calcium; Cardiovascular

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.05 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

During the past four decades, there has been a dramatic decline in the age-adjusted rate of death from cardiac disease in the United States and many other developed countries.1-3 This reduction is attributed in large part to primary and secondary prevention strategies that target modifiable risk factors. Despite these advances, cardiovascular disease remains the leading cause of death in developed countries as well as in most developing countries, and there is concern that the growing prevalence of obesity and type 2 diabetes will reverse the gains of the past 40 years. Furthermore, risk factors for cardiovascular disease are present and poorly controlled in the majority of persons who have no symptoms. Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program7 based its 2001 recommendations for the treatment of hypercholesterolemia for primary prevention of cardiovascular disease on the assessment of individual risk factors and global risk as indicated by the Framingham risk score, which is determined on the basis of age, blood pressure, levels of total cholesterol and HDL cholesterol, and smoking status. With the use of these criteria, persons without established coronary heart disease are considered to be at high risk if they have either a condition that is equivalent to coronary heart disease with respect to the risk of a coronary event (e.g., peripheral-artery atherosclerotic disease or diabetes) or more than a 20% estimated likelihood of a coronary event over the next 10 years; they are considered to be at low risk if the estimate is less than 10%.7 Although at the time of their first acute coronary event more than 85% of patients have at least one of the major established risk factors for heart disease,8,9 the presence of only a single risk factor would place most people in the low-risk category according to the ATP III criteria — meaning that intensive measures to reduce risk factors would not be considered necessary. The 2004 ATP III update10 also defined patients at “moderate risk” for a coronary event as those having two or more risk factors and a 10-year risk of less than 10% and patients at “moderately high” risk (previously termed “intermediate risk”) as those with a 10 to 20% likelihood of having a coronary event during the next 10 years. Neither patients at moderate risk nor those at moderately high risk would be considered candidates for the aggressive treatment of risk factors that is recommended for patients at high risk. The observation that a person classified as being at low, moderate, or moderately high risk for a coronary event according to the updated ATP III criteria10 may nonetheless have a coronary event has spurred interest in new markers of such risk that might identify those who would benefit from more rigorous attention to risk-factor modification.11-13 In this regard, the potential role for imaging of subclinical atherosclerosis — in particular, the use of electron-beam computed tomography (EBCT) or multidetector computed tomography (MDCT) to detect CAC — has generated considerable attention and debate.

Opini Anda

Klik untuk menuliskan opini Anda tentang koleksi ini!

Kembali