Intermediate Coronary Heart Disease Risk Research Articles

The Role of Advanced Lipid Testing in Clinical Practice

The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines recommend assessing an individual's cardiovascular (CV) risk from the Framingham risk score; however, the Framingham risk score may underestimate coronary heart disease (CHD) risk. Current guidelines have identified some emerging lipid risk factors that can be measured by several commercially available advanced cholesterol tests. These emerging lipid risk factors are meant to supplement the Framingham risk score to help the clinician to better assess CV risk. Although advanced lipid testing cannot be recommended for routine screening, it may be of value in individuals with a family history of premature CHD, postmenopausal women, and individuals at intermediate risk for CHD, especially if they are near the boundary of being at high risk. This review examines the role of advanced lipid testing in clinical practice.

Aspirin use for the primary prevention of coronary heart disease: A population-based study in Switzerland

Objective To determine the patterns of aspirin use for the primary prevention of coronary heart disease (CHD). Aspirin for primary prevention has a more favorable risk/benefit profile among adults with high CHD risk than among low-risk adults. Method We studied 5725 adults aged 35–75 without cardiovascular disease in a population-based study in Switzerland in 2003–2006. We examined regular aspirin use for cardiovascular prevention according to 10-year CHD risk and other cardiovascular risk factors. Results One hundred seventy-four participants used aspirin. Aspirin use increased with 10-year CHD risk, from 2.6% in persons with risk < 6% (low risk) to 9% in those with risk 6–20% (intermediate risk, p = 0.001), but no adults with risk ≥ 20% used aspirin. Participants with cardiovascular risk factors were more likely to use aspirin. However, 1.9% adults with risk < 6% and no diabetes used aspirin. Using a population perspective, a more appropriate aspirin use would reduce up to 2,348/24,310 CHD deaths expected over 10 years in Switzerland, and avoid about 700 gastrointestinal bleedings and hemorrhagic strokes among those not eligible. Conclusion Individuals at intermediate CHD risk and diabetics are more likely to take aspirin, but there are significant opportunities for improvement. The underuse of aspirin for those at risk coexists with an overuse among those at low risk.

Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests.

At least 25% of coronary patients have sudden death or nonfatal myocardial infarction without prior symptoms.1 Therefore, the search for coronary patients with subclinical disease who could potentially benefit from intensive primary prevention efforts is critically important. The American Heart Association’s (AHA) Prevention V Conference, “Beyond Secondary Prevention: Identifying the High Risk Patient for Primary Prevention,” addressed ways to identify more patients who are asymptomatic and clinically free of coronary heart disease (CHD) but at sufficiently high risk for a future coronary event to justify more intensive risk reduction efforts.2 In this report, we amplify on key findings and recommendations of the AHA Prevention V conference, highlight new research since the conference, and propose an approach to the use of office-based testing and additional noninvasive procedures in selected patients to better define their coronary event risk. The recommendations are concordant with the recently released approach to risk assessment and management from the third report of the Adult Treatment Panel of the National Cholesterol Education Program (ATP-III).3 Enthusiasm for primary prevention and risk assessment in asymptomatic people has been spurred by recent advances in prevention research. Lipid-lowering trials demonstrated that primary prevention of coronary events is feasible, evidenced by the West of Scotland Coronary Primary Prevention Study (WOSCOPS) trial4 of hypercholesterolemic men and by the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) trial5 in average or typical risk men and women with only moderate lipid abnormalities. Aspirin6 or ACE inhibitors7 can also reduce risk in selected asymptomatic, high-risk people. Emerging coronary risk factors have been described including inflammatory, infectious, and thrombotic markers,8 and there has been a steady flow of reports that focus attention on potential new ways of predicting coronary risk.9 In addition, noninvasive tests for subclinical atherosclerotic disease are available …