10-fold increased 10-fold increased risk; Calcium risk; Calcium imaging should be imaging should be routine routine Matthew J. Budoff, MD, FACC Matthew J. Budoff, MD, FACC Assistant Professor of Medicine Assistant Professor of Medicine Division of Cardiology Division of Cardiology Harbor-UCLA Medical Center Torrance, CA
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Scores >400 are are 10-fold Scores >400 are are 10-fold increased risk; Calcium increased risk; Calcium
imaging should be routineimaging should be routine
Matthew J. Budoff, MD, FACCMatthew J. Budoff, MD, FACCAssistant Professor of MedicineAssistant Professor of Medicine
Division of CardiologyDivision of CardiologyHarbor-UCLA Medical Center
Torrance, CA
Presenter Disclosure Information
DISCLOSURE INFORMATION:The following relationships exist related to this presentation:
Dr. Budoff is on the Speaker’s Bureau for Imatron, Inc.
Family History Diabetes Mellitus Elevated LDL Cholesterol Low HDL Cholesterol Tobacco Use Hypertension Obesity/Physical Inactivity
These risk factors
only explain
50-66%50-66% of cardiac
events
Over 50% of cardiac events occur in ‘intermediate risk’ patients, as classified by NCEP or Framingham risk analysis
70% of all events occur at mild stenosis (<50%)
Compliance with anti-atherosclerotic therapy is less than 50% at one year
The Challenge in Diagnosis ofThe Challenge in Diagnosis of CORONARY HEART DISEASECORONARY HEART DISEASE
Stress Testing is not enough
““The majority of people destined to die The majority of people destined to die suddenly will not have a positive exercise test. suddenly will not have a positive exercise test. The likely reason that they will die suddenly is The likely reason that they will die suddenly is that only a mild, non-flow -limiting coronary that only a mild, non-flow -limiting coronary plaque will have been present before the plaque will have been present before the sudden development of an occlusive sudden development of an occlusive thrombus.”thrombus.”
- Stephen Epstein - Stephen Epstein New England Medical Journal 1989New England Medical Journal 1989
Asymptomatic Patient Algorithm for Asymptomatic Patient Algorithm for Intermediate Risk PatientsIntermediate Risk Patients
Greenland P, et al. Circulation Oct 9, 2001
Refining Framingham Risk Score
EBT derived “Arterial Age”
a man is as old as his coronaries…
Syndenham 1689
% of Cases with Calcium Present prior to Cardiovascular Events
0%10%20%30%40%50%60%70%80%90%
100%
RiskFactors
Arad Agatston Georgio
““the finding of advanced the finding of advanced subclinical subclinical atherosclerosis by noninvasive testingatherosclerosis by noninvasive testing can be helpful for confirming the can be helpful for confirming the presence of high risk persons... and presence of high risk persons... and have utility in selected persons to guide have utility in selected persons to guide intensity of risk-reduction therapy”intensity of risk-reduction therapy”