Reclassification of patients for aggressive cholesterol treatment: Additive value of multislice coronary angiography to the national cholesterol education program guidelines

Abstract

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. © 2008 Wiley Periodicals, Inc.