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Revista argentina de cardiología
On-line version ISSN 1850-3748
Abstract
SINIAWSKI, Daniel A.; MASSON, Walter M. and BARBAGELATA, Leandro. Limitations of Cardiovascular Risk Scores in Primary Prevention. An Opportunity for Risk Modulators?. Rev. argent. cardiol. [online]. 2023, vol.91, n.2, pp.183-190. ISSN 1850-3748. http://dx.doi.org/10.7775/rac.v91.i2.20609.
Background:
Cardiovascular risk scores have limitations related to calibration, discrimination, and low sensitivity. Different "risk modulators" have been identified to improve cardiovascular risk stratification: carotid atherosclerotic plaque (CAP), coronary artery calcium (CAC) score and lipoprotein(a) [Lp(a)].
Objectives:
The aims of this study were: 1) to determine the prevalence of risk modulators mentioned in a primary prevention population; 2) determine the concordance between the 2 methods of detecting subclinical atherosclerosis; and 3) establish which proportion of patients should receive statins according to the initial risk stratification and after being recategorized by screening for risk modulators.
Methods:
Individuals aged 18 to 79 years who consulted for cardiovascular risk assessment and who were not receiving lipid-lowering treatment were included. The risk score was calculated in each patient using ASCVD Risk Estimator. The presence of CAP, CAC score and Lp(a) level were evaluated.
Results:
The cohort was made up of 348 patients; mean age was 55.6 ± 12.2 years and 45.4% were men. In the total population, 29.8%, 36.8%, and 53.2% of patients showed Lp(a) value 50 mg/dL, CAP, or a CAC score > 0, respectively. The prevalence of CAP and CAC score was progressively higher according to the cardiovascular risk category; however, the proportion of low-risk subjects who had risk modulators was considerable (Lp(a) 50 mg/dl: 25.7%; CAP: 22%; CAC score > 0: 33%). In the 60 subjects <45 years, the prevalence of CAC score > 0 and CAP was 18.3% and 10%, respectively. The agreement between the two methods for quantifying subclinical atheromatosis was fair (kappa= 0.33). The indication for statin treatment increased by 31.6% after evaluating the presence of modulators.
Conclusion:
The presence of risk modulators was common in this population in primary prevention, even in low-risk subjects or < 45 years. Detection of risk modulators could improve initial stratification and lead to reconsideration of statin treatment.
Keywords : Risk Assessment; Risk Assessment; Plaque; Atherosclerotic; Carotid Artery Diseases; Vascular calcification; Lipoprotein(a); Primary prevention; Hydroxymethylglutaryl; CoA Reductase Inhibitors; Heart Disease Risk Factors.
