新chd危险因素及评估方法.pptVIP

Effects of Lipid-LoweringAgents on Fibrinogen No consistent benefit seen with statins Fibrates have shown benefit in most studies Levels reduced with apheresis Nicotinic acid has shown a modest reduction in some but not all studies Predictive value of CAC score In a 2-year prospective study of 1173 asymptomatic patients without documented CHD, coronary artery calcium (CAC) was measured by electron beam CT and found to be predictive of CVD events. Patients with CAC score $100 had a positive predictive value (PPV) of 5.5%, whereas patients with CAC scores $680 had a PPV of 14.0%. Negative predictive value (NPV) was 99% for all CAC score thresholds. Reference: Arad Y, Spadaro LA, Goodman K, Lledo-Perez A, Sherman S, Lerner G, Guerci AD. Predictive value of electron beam computed tomography of the coronary arteries. 19-month follow-up of 1173 asymptomatic subjects. Circulation 1996;93:1951-1953. * Limited predictivity of coronary calcium score for coronary events: ROC curve areas In contrast, a 41-month study of 1196 asymptomatic high-risk patients without previous CHD events found that electron beam CT did not add predictive information to risk equations such as the one developed by the Framingham Heart Study investigators. In this study, neither risk factor algorithms nor CT-assessed calcium score accurately predicted future CHD events. The completion of the National Heart, Lung, and Blood Institutes Subclinical Cardiovascular Disease Study in 18,000 men and women should help clarify which diagnostic tests are useful for risk assessment. Reference: Detrano RC, Wong ND, Doherty TM, Shavelle RM, Tang W, Ginzton LE, Budoff MJ, Narahara KA. Coronary calcium does not accurately predict near-term future coronary events in high-risk adults. Circulation 1999;99:2633-2638. * CT monitoring of effect of therapy on plaque volume Electron beam CT has also been used to monitor the change in calcium score with statin therapy. In a retrospective study of 149 men and women with