BACKGROUND:National Cholesterol Education Program (NCEP) guidelines have been used to define treatment goals in patients with hypercholesterolemia. However, epidemiology-based guidelines are unable to identify all subjects with coronary artery disease for aggressive lipid intervention. OBJECTIVE:We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment. METHODS:Multislice computed tomography was performed in 114 consecutive patients (mean age 57+/-14 y; 59% male) without known coronary artery disease. Subjects were classified into 3 categories (low-, intermediate-, and high-risk) according to their Framingham risk scores (FRS). RESULTS:Traditional cardiac risk factors were common: hypertension 59%, diabetes 13%, and smoking 22%. On the basis of the FRS, 11% (n=12/114) of the patients met high-risk criteria requiring aggressive cholesterol reduction. Of those in the low- and intermediate-risk groups, MSCT found coronary plaque in 76% (n=77/102), with moderate or severe plaque in 38% (n=39/102), thus reclassifying them in the high-risk category. Use of statin drugs increased from 32% at baseline to 53% (p=0.002) based on MSCT results; statin dose was increased in 31% of the patients who were already on a statin. The mean low-density lipoprotein cholesterol (LDL-c) decreased from 114 mg/dL to 91 mg/dL after MSCT (p<0.001). CONCLUSION:Multislice computed tomography reclassifies a high percentage of patients considered to be low- to intermediate-risk into the high-risk category based on their coronary artery lesions. Thus, the rise in MSCT use at present may have a large impact on clinician practice patterns in lipid-lowering therapy.

译文

背景:国家胆固醇教育计划(NCEP)指南已用于定义高胆固醇血症患者的治疗目标。但是,基于流行病学的指南无法识别出患有冠状动脉疾病的所有受试者进行积极的脂质干预。
目的:我们试图评估多层计算机断层扫描(MSCT)血管造影对脂质治疗的NCEP指南分类的附加价值。
方法:对114例无已知冠状动脉疾病的连续患者(平均年龄57 / -14岁;男性59%)进行了多层计算机断层扫描。根据弗雷明汉风险评分(FRS)将受试者分为3类(低,中和高风险)。
结果:传统的心脏危险因素是常见的:高血压59%,糖尿病13%,吸烟22%。根据FRS,11%(n = 12/114)的患者符合需要积极降低胆固醇的高风险标准。在低危和中危组中,MSCT发现冠状动脉斑块占76%(n = 77/102),中度或重度斑块占38%(n = 39/102),因此将其重新分类为高危风险类别。根据MSCT结果,他汀类药物的使用从基线的32%增加到53%(p = 0.002);在已经接受他汀类药物治疗的患者中,有31%的患者增加了他汀类药物的剂量。 MSCT后,平均低密度脂蛋白胆固醇(LDL-c)从114 mg / dL降至91 mg / dL(p <0.001)。
结论:多层计算机断层扫描根据其冠状动脉病变将高百分比的被认为是低风险至中风险的患者重新分类为高风险类别。因此,目前MSCT使用量的增加可能对降脂治疗中临床医生的实践模式产生重大影响。

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