Reclassification of patients for aggressive cholesterol treatment: additive value of multi-slice coronary angiography to the National Cholesterol Education Program guidelines

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Reclassification of patients for aggressive cholesterol treatment: additive value of multi-slice coronary angiography to the National Cholesterol Education Program guidelines

Reclassification of patients for aggressive cholesterol treatment: additive value of multi-slice coronary angiography to the National Cholesterol Education Program guidelines

Gian Mendez NOVARO MD

Florida, Weston
Cardiology

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* Date : 03-24-2009 - 10:08 PM (5504 days ago),

* Characters : 1755, Words : 250, Size : 1.71 Kb.

Reclassification of patients for aggressive cholesterol treatment: additive value of multi-slice coronary angiography to the National Cholesterol Education Program guidelines

BACKGROUND: National Cholesterol Education Program (NCEP) guidelines have been used to define treatment goals in patients with hypercholesterolemia. However, epidemiology-based guidelines are unable to identify all subjects with coronary artery disease for aggressive lipid intervention. OBJECTIVE: We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment. METHODS: Multislice computed tomography was performed in 114 consecutive patients (mean age 57+/-14 y; 59% male) without known coronary artery disease. Subjects were classified into 3 categories (low-, intermediate-, and high-risk) according to their Framingham risk scores (FRS). RESULTS: Traditional cardiac risk factors were common: hypertension 59%, diabetes 13%, and smoking 22%. On the basis of the FRS, 11% (n=12/114) of the patients met high-risk criteria requiring aggressive cholesterol reduction. Of those in the low- and intermediate-risk groups, MSCT found coronary plaque in 76% (n=77/102), with moderate or severe plaque in 38% (n=39/102), thus reclassifying them in the high-risk category. Use of statin drugs increased from 32% at baseline to 53% (p=0.002) based on MSCT results; statin dose was increased in 31% of the patients who were already on a statin. The mean low-density lipoprotein cholesterol (LDL-c) decreased from 114 mg/dL to 91 mg/dL after MSCT (p<0.001). CONCLUSION: Multislice computed tomography reclassifies a high percentage of patients considered to be low- to intermediate-risk into the high-risk category based on their coronary artery lesions. Thus, the rise in MSCT use at present may have a large impact on clinician practice patterns in lipid-lowering therapy.

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