The Resource Screening for intermediate risk factors for coronary heart disease, investigators, Mark Helfand ... [et al.], (electronic resource)

Screening for intermediate risk factors for coronary heart disease, investigators, Mark Helfand ... [et al.], (electronic resource)

Label
Screening for intermediate risk factors for coronary heart disease
Title
Screening for intermediate risk factors for coronary heart disease
Statement of responsibility
investigators, Mark Helfand ... [et al.]
Contributor
Subject
Language
eng
Summary
OBJECTIVES: In the United States, coronary heart disease and cardiovascular disease account for nearly 40% of deaths each year. An individual's estimated risk for coronary heart disease events, often based on factors incorporated into the Framingham risk score, guides the intensity of risk reduction interventions. We conducted a systematic review of epidemiologic studies to help the U.S. Preventive Services Task Force determine which, if any, of 9 additional risk factors should be considered for incorporation into guidelines for coronary and cardiovascular risk assessment in primary care. DATA SOURCES: We conducted multiple searches of MEDLINE (1966 to March 2006) for epidemiologic studies relevant to the independent predictive ability of the risk factor when used in intermediate-risk individuals. We obtained additional articles from recent systematic reviews, reference lists of pertinent studies, reviews, editorials, websites, and by consulting experts. REVIEW METHODS: We rated the validity and applicability of each included study and characterized several dimensions of the body of evidence for each risk factor. For applicability, we assessed whether the study was drawn from the general population or a demographic subset of asymptomatic adults; whether it included or focused on intermediate-risk individuals (those who have a 10% - 20% 10-year risk of coronary heart disease events); and the measurement of the Framingham and emerging risk factors and of endpoints. We conducted several meta-analyses of the ability of each of the risk factors to predict major coronary heart disease events independently of Framingham risk factors in intermediate-risk subjects. RESULTS: Results of the literature review are summarized in the Tables. There are no definitive data from randomized trials on how use of any of these factors in risk assessment would affect cardiac morbidity and mortality. We used a mathematical model to assess the potential impact of using a test for C-reactive protein in intermediate-risk individuals. Under the assumption that those reclassified as high risk (>20% 10-year risk) would have a 30% reduction in the 10-year risk of coronary heart disease events, the main finding was that, use of C-reactive protein could reclassify enough intermediate-risk men to have a major impact. CONCLUSION: Several emerging risk factors provided independent information about coronary heart disease risk, but for most there were limitations in the evidence base. Across all of the criteria listed in the table, C-reactive and electron beam computed tomography scan had the strongest evidence for an independent effect in intermediate-risk individuals, and both reclassify some individuals as high-risk. However, data on electron beam computed tomography are relatively sparse, the technique is more expensive, and its potential harms require more investigation. Periodontal disease, carotid intima media thickness, homocysteine, and lipoprotein(a) probably provide independent information about coronary heart disease risk, but data about their prevalence and impact when added to Framingham risk score in intermediate-risk individuals are limited
Member of
Cataloging source
DNLM
Funding information
This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239 under contract to the Agency for Healthcare Research and Quality (AHRQ) 540 Gaither Road, Rockville, MD 20850. www.ahrq.gov (Contract No. 290-02-0024).
NLM call number
WG 300
http://library.link/vocab/relatedWorkOrContributorName
  • Helfand, Mark
  • Oregon Health & Science University
  • United States
Series statement
Evidence syntheses
Series volume
no. 73
http://library.link/vocab/subjectName
  • Coronary Disease
  • Risk Factors
  • Risk Assessment
Label
Screening for intermediate risk factors for coronary heart disease, investigators, Mark Helfand ... [et al.], (electronic resource)
Instantiates
Publication
Note
  • Title from home page caption
  • "Report no. 10-05141-EF-1."
Bibliography note
Includes bibliographical references
Control code
OCM1bookssj0000997882
Dimensions
unknown
Specific material designation
remote
System control number
(WaSeSS)bookssj0000997882
System details
Mode of access: World Wide Web
Label
Screening for intermediate risk factors for coronary heart disease, investigators, Mark Helfand ... [et al.], (electronic resource)
Publication
Note
  • Title from home page caption
  • "Report no. 10-05141-EF-1."
Bibliography note
Includes bibliographical references
Control code
OCM1bookssj0000997882
Dimensions
unknown
Specific material designation
remote
System control number
(WaSeSS)bookssj0000997882
System details
Mode of access: World Wide Web

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