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The framingham risk score (FRS) is an important tool to stratify the risk for cardiovascular (CV) events and death. coronary artery calcium score (CACS) is another method for the assessment of CV risk. this study's objective is to quantitate the magnitude and determine the type of discordance in two different patient populations, a middle eastern (ME) as well as a veteran american population (US).
This is a retrospective observational cohort of 322 consecutive patients who underwent multidetector cardiac computerized tomography (CCT) at king fahd armed forces hospital (KFAFH), jeddah, saudi arabia and the veterans affairs loma linda health care system (VALLHCS). CACS was measured using agatston method. FRS was calculated by chart review. Discordance was defined as a CACS of <100 with high FRS or a CACS of >400 with low FRS. Patients with a CASC between 100 and 400 were excluded. Statistical analysis was performed using SPSS software (14.0, SPSS Inc., Chicago, IL, USA). Quantitative variables were expressed as mean ± standard deviation (SD). Categorical variables were expressed as frequencies or percentages. Agreement between CACS and FRS was assessed using Pearson correlation.
Three hundred twenty two patient charts were reviewed. one hundred and six from the VALLHCS (age 63±12, 95% males) and 216 from KFAFH (age 48±12, 27% males). in the us population, of the 50 patients with CACS <100, only one had a discordantly high FRS & of the 56 patients with a CACS >400, 17 had a discordantly low FRS. in the ME population, of the 196 patients with a CACS <100, 190 had discordantly high FRS & of the 20 patients with a CACS >400, only 3 had a discordantly low FRS (Table).
Discordance was found in a significant percentage (65%) of the total population. a majority of the discordance in the ME population had a high FRS with a low CACS. in contradistinction, the US veterans with discordance had a high CACS with a low FRS, suggesting etiologic factors that are not accounted for by the FRS. therefore, discordant populations are important targets for future investigation into the etiology of atherosclerotic CV disease. upon evaluating the baseline characteristics of the two patient groups the age of the ME population was much younger which could explain the predominantly low CACS when compared with the US veteran population.
- 2013 American College of Cardiology Foundation