Is There a Role for Coronary Artery Calcium Scoring for Management of Asymptomatic Patients at Risk for Coronary Artery Disease?Response to Andersson and Vasan
Clinical Risk Scores Are Sufficient To Define Primary Prevention Treatment Strategies Among Asymptomatic Patients
Adequate screening for identifying individuals at risk of developing cardiovascular disease (CVD) is important because vascular disorders are a preventable cause of morbidity and mortality worldwide. Furthermore, the lifetime risk of developing CVD is high (an estimated 66% for men and >50% for women), and often the first symptom of disease is a sudden death, thereby occurring without an opportunity for intervention.1–3 Conventional risk factors aggregated as risk scores (such as the National Heart, Lung, and Blood Institute report on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel III, based on the Framingham risk score]) have shown to predict the 10-year risk of developing coronary heart disease (CHD) in most individuals,4,5 and the predictive capability of these risk factors extends during a 30-year time horizon.6 However, established risk scores may underestimate CVD risk in some individuals.7 In addition, it is also recognized now that even among those with an optimal risk factor profile at 55 years of age, the residual lifetime risk of CVD remains substantial (40% in men and 30% in women).3 These observations have motivated the search for additional risk factors (including imaging tests that detect subclinical atherosclerosis) that can enhance the predictive use of conventional risk factors.
Response by Blaha et al see p 397
The underestimation of CVD risk may be especially evident in people with a family history of premature CVD.8–10 Independent of established risk factors, a positive family history has been associated with a greater prevalence of subclinical atherosclerosis (such as an increased coronary artery calcium [CAC] score obtained by coronary computerized tomography [CCT]).11,12 Estimation of the CAC score is, therefore, currently considered a valuable supplement to the Framingham Risk Score for the assessment …