A new strategy for evaluating coronary risk in primary prevention

作者：Simon Alain^*

来源：Bulletin de l Academie Nationale de Medecine, 2013, 197(3): 631-640.

• CORONARY DISEASE
• RISK FACTORS
• ATHEROSCLEROSIS
• PRIMARY PREVENTION

Prevention of coronary heart disease is a priority for cardiovascular prevention, as coronary deaths account for half of all cardiovascular deaths. About 20 % of coronary events occur in high-risk but asymptomatic and apparently healthy subjects. Such patients can be identified by using a novel two-step strategy to evaluate the coronary risk. The first step is obligatory and is based on simple calculation of a multifactorial risk score derived from the Framingham study and integrating all traditional cardiovascular risk factors. The Framingham risk score can be used to estimate the 10-year probability of fatal and non-fatal coronary heart disease and to identify subjects at high coronary risk (probability greater than 20 %). The second step is optional and mainly concerns subjects with Framingham scores between 10 % and 20 % (intermediate risk). A substantial proportion of these subjects are incorrectly classified by the Framingham score and are in fact at high risk Risk requalification is based mainly on non-invasive imaging of preclinical atherosclerosis in extracranial carotid arteries (ultrasound-assessed plaque) or in coronary arteries (no-contrast CT assessment of coronary calcium). This novel strategy for coronary risk evaluation could help to maintain and improve the ongoing regression of cardiovascular mortality, especially in women and elderly people.

• 出版日期2013-3