Framingham risk score and extent of atherosclerosis in non-diabetic patients with suspected coronary artery disease

Accurate identification of individuals who will benefit most from CAD risk reduction should result in a substantial reduction in morbidity and mortality. One of the most common, well known risk assessment engines is the Framingham risk score (FRS) which is recommended for the initial assessment of the majority of patients in the primary prevention category. However, its moderate or limited predictive value highlights the potential utility of direct imaging modalities as MSCT coronary angiography for accurate identification of coronary atherosclerosis. To study the relationship between coronary artery disease risk as calculated by Framingham risk score (FRS) and the extent of atherosclerotic burden as assessed by MSCT coronary angiography among symptomatic patients with chest pain. Our study was carried out at Zagazig university hospitals, cardiovascular department and Kobry Elkoba military hospital on 80 consecutive adult patients of both genders, referred to do MSCT coronary angiography, in the period between October (2015) and December (2016). All patients included were non-diabetic and where further subdivided according to their FRS into low, intermediate and high risk groups. We found a positive, significant relationship between FRS and both total plaque volume, and calcium score (p = 0.002 and 0.026, respectively), number of segments affected (p = 0.002) measured by MDCT. However, no statistically significant relation was found between Framingham risk score and number of proximal coronary plaques in LAD, LCx and RCA measured by MSCT (p-value = 0.982, 0.733 and 0.939, respectively) and similarly none was between plaque composition (lipid, fibrous or calcified) and FRS (p = 0.53, 0.345 and 0.631, respectively). From our results, we concluded that FRS is a good predictor of Total Plaque Score and volume, but it cannot be used as a tool for the assessment of plaque vulnerability as it lacks any correlation with the plaque composition and distribution.