By John A. Rumberger, PhD, MD, FACC, FSCCT
The FRS [Framingham, Massachusetts Risk Factor Study] has been evaluating long term cardiovascular risk and prediction of future cardiovascular events using various ‘risk’ factors [e.g. smoking, cholesterol, high blood pressure, etc.] since 1948; and continues to go strong.
Nearly all clinicians have been taught that these collective risk factors can then be used to estimate who is ‘at risk’ and who needs more aggressive risk factor modification such that future cardiovascular events can be potentially avoided or at least delayed.
However, there have been challenges to using a single measurement at one time [such as your blood pressure, your cholesterol, whether you smoke, etc.] to then ‘predict’ the future into the next decade.
Coronary and other systemic arteries and valvular ‘calcification’ has proved to be an excellent predictor of future cardiovascular events because their presence and magnitude reflect the ‘big history’ of atherosclerotic plaque development over the individual’s lifetime – not just one moment in time.
The researchers at FRS began using non-contrast CT analysis of coronary, valve, aortic, and other vascular calcifications in conjunction with traditional epidemiologic studies about 10-15 years ago.
These researchers recently published their studies to determine whether vascular and valvular calcification predicted major coronary and cardiovascular disease and all-cause mortality independent of Framingham risk factors in the community based FRS [J Am Heart Assoc 2016:5:e003144].
A total of 3486 study participants [51% women, mean age 50+10 years] were followed a median of 8 years. Coronary artery calcification was most strongly associated with major coronary heart disease, followed by major cardiovascular disease and all-cause mortality independent of Framingham risk factors. Furthermore, CAC [coronary artery calcification] accurately RE-CLASSIFIED 85% of the 261 patients who were at intermediate [Framingham 5-10%] 10-year risk for coronary heart disease to truly low or truly high risk.
They concluded that CAC improves discrimination and risk re-classification for major coronary heart disease and cardiovascular disease beyond risk factors in asymptomatic community dwelling persons and accurately re-classifies two-thirds of the intermediate Framingham ‘risk’ population.
COMMENTS: John A. Rumberger, PhD, MD, FSCCT – Director of Cardiac CT and Lipid Management, the Princeton Longevity Center
We have advocated at PLC since the centers have opened that a non-contrast CT scan assessment of coronary and vascular calcification allows for the most accurate individualization of long term cardiovascular risk in conjunction with performance of a comprehensive medical examination; incorporating FRS risk assessment.