Detection of high-risk young adults and women by coronary calcium and National Cholesterol Education Program Panel III guidelines

OBJECTIVES The purpose of this study was to investigate the classification of cardiovascular risk in young individuals and women according to the National Cholesterol Education Program (NCEP) guidelines across a continuum of coronary calcium scores (CCS). BACKGROUND Current NCEP guidelines might underestimate cardiovascular risk in young individuals and women. METHODS The study population consisted of 1,611 asymptomatic individuals (67% men, mean age: 53 +/- 10 years) who presented to a single electron beam tomography facility for coronary artery calcium screening. Participants were categorized into low-risk (n = 738, 46%), intermediate-risk (n = 583, 36%), moderately high-risk (n = 263, 16%), and high-risk (n 27, 2%) according to the NCEP Panel III guidelines. RESULTS Absence of calcium, CCS of 0 to 99 (mild), 100 to 399 (moderate), and >= 400 (severe), was observed in 572 (35%), 707 (44%), 192 (12%), and 140 (9%) of the patients, respectively. A high CCS percentile (>= 75th percentile) was present in 426 (26%) individuals. Overall, 59% and 78% of participants with CCS >= 400 and CCS >= 75th percentile were not identified as high risk and candidates for pharmacotherapy on the basis of NCEP categories. Furthermore, women as well as young individuals were less likely to be considered candidates for pharmacotherapy compared with men and older individuals in each CCS category. CONCLUSIONS The NCEP guidelines seem to underestimate cardiovascular risk in young asymptornatic individuals and women. For these individuals, assessment of plaque burden might provide incremental value to global risk assessment.