Novel Risk Factors for Coronary Artery Disease Prevention: Fact or Fiction?

Philip Liebson; JoAnne Foody; Ezra Amsterdam

Novel Risk Factors for Coronary Artery Disease Prevention: Fact or Fiction?

Moderator:

Philip R. Liebson, MD, FACP, FACC, FAHA

Rush University Medical Center

Discussants:

Date: September 7, 2010

Roundtable ID: CV0033

Citation: Med Roundtable Cardiovasc Ed. ; 1(4): 236 - 242.

Summary:
Dr. Philip Liebson from Rush Medical College moderated the topic "Novel Risk Factors for Coronary Artery Disease Prevention: Fact or Fiction?" with Drs. Ezra Amsterdam from the University of California, Davis and JoAnne Foody from Harvard Medical School participating.

The discussion focused primarily on:

(1) classic cardiovascular risk factors and Framingham risk score,

(2) definition of risk factors vs. risk markers,

(3) novel risk markers such as hs-CRP, coronary calcium scores, Lp(a), Carotid IMT, Ankle Brachial Index, Nuclear Magnetic Resonance Spectroscopy, Computed Tomography Coronary Angiography and PAI-1,

(4) explaining the C statistic,

(5) the incremental value of the tests compared to the costs,

(6) the Reynolds Risk Score,

(7) obesity as a risk factor.

(Med Roundtable Cardiovasc Ed. 2010;1(4):236-242) ©2010 FoxP2 Media, LLC

Compounds:
No compounds discussed.

Trials:
FRAMINGHAM HEART STUDY, INTERHEART, JUPITER, VA-HIT

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“…it’s been bandied about that the classic risk factors account for only 50% of the risk of atherosclerotic vascular disease. … We refer to this as the ‘50% myth’ and we need to refute it.”
~ Ezra Amsterdam MD

“One of the problems with this romance with the novel risk factors—I call it a romance—is that some clinicians are so enthralled with them that they neglect the traditional, unexciting, uninspiring risk factors.”
~ Ezra Amsterdam, MD

“I think the bigger issue is non-adherence to our current guidelines.”
~ JoAnne Foody, MD

“… to evaluate a novel risk factor, you have to show that management guided by novel risk markers improves clinical outcomes and there is an incremental improvement in outcome justifying additional costs of testing and treatment.”
~ Philip Liebson, MD