| Prevention and early detection of CAD are crucial to improving disease management and outcomes in women. Initial screening and assessment of CAD risk should be initiated in the primary care setting. A number of relatively simple tools are available for office-based cardiac risk assessment.
Adult Treatment Panel III
The third report of the National Cholesterol Education Program's Adult Treatment Panel III (ATP III) describes a cardiac risk-assessment system based on major risk factors for CHD (Table 3).43
Table 3. CAD Risk Assessment Based on ATP III43, 52
*HDL cholesterol >60 mg/dL counts as a "negative risk factor" and removes 1 risk factor from the patient's total count. Adapted from JAMA. 2001;285:2486-2497.
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Risk Factors
Office-Based Risk Assessment
Risk Reduction
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The score obtained using the model above is used to determine a patient's 10-year risk of experiencing a coronary event (Table 4).52
Table 4. 10-Year Risk Based on Risk-Factor Scoring52
A functional electronic algorithm based on ATP III is available at http://www.nhlbi.nih.gov/guidelines/cholesterol/. For important updated information on the ATP III guidelines, see the 2004 paper by Grundy et al.53
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Framingham Score
The Framingham score is another simple tool for estimating a woman's 10-year risk for CHD (Figure 5).54 Points are allocated based on age, lipid-profile and blood-pressure measurements, and smoking status. A woman's point total is then used to estimate her 10-year coronary risk.
Figure 5. Framingham Point Score: Estimating 10-Year Risk for Women54
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C-Reactive Protein
C-Reactive Protein (CRP) is being increasingly recognized as a predictor of heart disease. Recommendations for clinical practice from the Centers for Disease Control and Prevention and the American Heart Association support the use of CRP testing to help assess cardiovascular risk in patients already determined to have an intermediate (10% to 20%) coronary risk.55 Higher CRP levels correlate with higher risk (Table 5).
Table 5. CRP Levels and Associated Risk56 |
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Ankle-Brachial Index
Ankle-brachial undex (ABI) measurement is a relatively simple screening tool that can help identify cardiovascular risk among asymptomatic individuals from the general public.57 ABI is determined by comparing the systolic blood pressure at the ankle with that at the arm. A low ABI (<0.9) is associated with an increased risk for CHD, cardiovascular mortality, stroke, and all-cause mortality.57 ABI measurement can also be used to follow disease progression and guide and evaluate treatment.
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