Electron beam tomography and National Cholesterol Education Program guidelines in asymptomatic women

OBJECTIVES This investigation was designed to determine the relationship be tween National Cholesterol Education Program (NCEP) ATP-II lipid guidelines and subclinical atherosclerosis, defined by electron beam tomography (EBT) calcified coronary plaque, in asymptomatic women. BACKGROUND NCEP guidelines are used to identify women at increased risk for coronary artery disease (CAD) on the basis of low density lipoprotein chol esterol (LDLC) and high density lipoprotein cholesterol (HDLC) values. The relationship of the guidelines to subclinical atherosclerosis is unknown. METHODS A total of 304 asymptomatic women underwent lipid and EBT evaluatio n and were classified as: 1) NCEP higher risk, with LDLC greater than or eq ual to 130 mg/dl and/or HDLC <35 mg/dl, or lower risk with LDLC <130 mg/dl and HDLC greater than or equal to 35 mg/dl; and 2) EBT+ if any calcified pl aque was noted or EBT- if there was no calcified plaque. RESULTS Forty-two percent of patients were EBT+, with a mean score of 227 a nd percentile of 73%; 58% were EBT-. Women who were EBT+ had significantly higher total cholesterol, LDLC and triglycerides than EBT- women, but only with ages less than or equal to 55 years; women >55 years demonstrated no d ifferences. NCEP higher risk women made up 53.5% of the EBT+ and 37.7% of t he EBT- groups; NCEP lower risk women accounted for 46.5% of the EBT+ and 6 2.3%, of the EBT- groups. Assuming a higher risk in subjects with EBT-defin ed subclinical CAD than in those without, only 58.6% of the total group wou ld be correctly identified by NCEP guidelines as either higher or lower ris k, with correct identification of 65.5% of the younger and 52.2% of the old er women. There was no correlation between either calcium percentile or sco re and any: lipid measurement. CONCLUSIONS This study demonstrates the shortcomings of employing NCEP guid elines to identify asymptomatic women with subclinical CAD, particularly wo men >55 years, and suggests increased utilization of EBT for primary preven tion in the female population. (J Am Coll Cardiol 2001;337:1506-11) (C) 200 1 by the American College of Cardiology.