Abstract 9634: Reclassification of Cardiovascular Risk by Including Ultrasound Detected Plaque of the Femoral and Carotid Arteries Improves Identification of High-Risk Subjects

Abstract

Background: Current Cardiovascular Disease (CVD) predictive algorithms recognize traditional risk factors in populations but have failed to identify many of those at highest risk because of detectable vascular disease. We compared an enhanced algorithm, "Lifetime Risk" (LR), with Framingham Risk Score (FRS) algorithms both 10-yr and 30-yr in their ability to identify subjects at highest risk for developing an initial CVD event by including ultrasound detected carotid or femoral artery plaque. Methods: We performed Ultrasound Examination (UE) of both carotid and femoral arteries in 939 adults (36% women) between the ages of 30 and 60 after excluding those with previous CVD (myocardial infarction, angina, stroke or claudication). Subjects were categorized into low-, intermediate- and high-risk groups on the basis of respective published criteria for the algorithms. Subjects in the low- and intermediate-risk groups were reclassified as high risk if UE showed any arterial plaque. Results: Overall, low- and intermediate-risk men allocated by LR required less reclassification(17%) than men allocated by 30-yr FRS (24%) (p<0.001) or 10-yr FRS (37%) (p<0.001) because of plaque detected by UE. Similarly, low- and intermediate-risk women allocated by LR required less reclassification (14%) than women allocated byy 30-yr FRS (24%) (p<0.001) or 10-yr FRS (31%) (p<0.001) (Table). Of men categorized as low risk by 10-yr FRS (23%) and LR (24%) were reclassified as high-risk and of women categorized as low-risk by 10-yr FRS (25%), 30-yr FRS (13%) and LR (24%) wre reclassified as high-risk because of plaque detected by UE. Conclusions: Our study which included UE of easily accessible arteries showed increased sensitivity of LR, compared to 10-yr and 30-yr FRS, for the identification of both males and females at high risk for CVD events based on the presence of easily detectable arterial plaque.