Coronary plaque as a replacement for age as a risk factor in global risk assessment

Risk assessment is assuming an increasing role for identification of high-risk persons for intensive medical intervention to reduce risk for coronary heart disease (CHD). Of particular importance is the need to identify those persons with CHD risk equivalents who can be managed with the same intensity as patients with established CHD. For example, the National Cholesterol Education Program (NCEP) recently classified diabetes as a CHD risk equivalent. The NCEP also recommended use of Framingham risk scoring in persons with multiple (2+) risk factors to uncover others without diabetes who have CHD risk equivalents. One limitation of Framingham risk scoring, however, is that age becomes the dominant risk factor after age 50. Age is a surrogate for coronary atherosclerotic plaque burden, which is the true risk factor. However, for individuals, coronary plaque burden can vary greatly at any given age. For this reason, if coronary plaque burden could be measured accurately with noninvasive techniques, the degree of plaque burden could be used to replace age as a risk factor in Framingham scoring for risk prediction. This article describes a technique whereby such a replacement can be made.