Why the study?
The clinical utility of using nontraditional risk factors to improve coronary heart disease risk assessment in asymptomatic persons was uncertain.
Does screening with nontraditional risk factors prevent CHD events in asymptomatic men and women with no history of CHD?
Systematic Review
Does screening with nontraditional risk factors prevent CHD events in asymptomatic men and women with no history of CHD?
The USPSTF issued an 'I' statement, concluding there is insufficient evidence to recommend using nontraditional risk factors for CHD screening in asymptomatic individuals.
Answers are grounded in this paper and cite their sources.
Insufficient evidence precludes routine use of nontraditional risk factors for CHD screening; leaves open whether targeted application improves outcomes.
DESCRIPTION: New recommendation from the U.S. Preventive Services Task Force (USPSTF) on the use of nontraditional, or novel, risk factors in assessing the coronary heart disease (CHD) risk of asymptomatic persons. METHODS: Systematic reviews were conducted of literature since 1996 on 9 proposed nontraditional markers of CHD risk: high-sensitivity C-reactive protein, ankle-brachial index, leukocyte count, fasting blood glucose, periodontal disease, carotid intima-media thickness, coronary artery calcification score on electron-beam computed tomography, homocysteine, and lipoprotein(a). The reviews followed a hierarchical approach aimed at determining which factors could practically and definitively reassign persons assessed as intermediate-risk according to their Framingham score to either a high-risk or low-risk strata, and thereby improve outcomes by means of aggressive risk-factor modification in those newly assigned to the high-risk stratum. RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors studied to screen asymptomatic men and women with no history of CHD to prevent CHD events. (I statement).
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A 2009 study conducted a systematic review in Coronary heart disease risk assessment. Nontraditional risk factors (e.g., hs-CRP, ABI, CAC score) vs. Standard risk assessment (Framingham score) was evaluated on Reassignment of intermediate-risk persons to high-risk or low-risk strata and improvement of outcomes. Current evidence is insufficient to assess the balance of benefits and harms of using nontraditional risk factors to screen asymptomatic adults with no history of CHD to prevent CHD events.
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