The medical community has often attempted to devise methods at identifying those individuals at risk for a myocardial infarction, sudden death related to coronary artery disease, and coronary artery disease in general. This has been of particular interest due to the numerous individuals who experience cardiac events yearly. Nearly 1.5 million cases of acute coronary syndrome occurs each year and it has been estimated that nearly 25% of patients never realize that they have coronary artery disease until they experience a lethal cardiac event. This has not only been a problem that the medical community has been grappling with, but one that often causes a great deal of anxiety amongst patients.

It is alarming to think that you may not know you have a disease until it ends your life. In order to find the patient population most at risk for experiencing a cardiac event and provide treatment prior to an event the Framingham Score was put forth.

The Framingham Score essentially takes into account the numerous known risk factors associated with cardiac events and then stratifies the patient population into those likely to experience a cardiac event and those that are not very likely. The risk factors that serve as variables in the Framingham Score are age, sex, smoking history, blood pressure, cholesterol, high-density lipoprotein cholesterol (bad cholesterol), and blood glucose levels or history of diabetes. The Framingham Score will help find those individuals who are at risk based upon the previously mentioned risk factors and who have yet to be diagnosed with coronary artery disease. A non-invasive test has also been devised to aid in finding those individuals at risk and is known as the coronary artery calcium score.

The coronary artery calcium score utilizes computer tomography images to look at calcium deposition within the coronary arteries. Calcium deposition is often a step in the pathogenesis of an atherosclerotic plaque that clogs your arteries. It has been shown that the amount of calcium does, to a certain extent, translate into your chance of having a cardiac event. Both the Framingham score and the coronary artery calcium score have utility in independently identifying the patient population at risk. New studies have shown that perhaps the two could be combined to form an even stronger prognosticator of cardiac events.

In a recent article in the Journal of the American Medical Association this very question was posed and answered. It was found that both could predict the likelihood of cardiac events, but that a combination was of significant utility. More specifically it was shown that an intermediate Framingham Score of 10% to 19 % likelihood in ten years of an event when combined with a coronary artery calcium score could further stratify that group to find those who would be aided by additional therapy. In essence those whose Framingham risk was neither too high nor too low were "in a limbo". One did not know how aggressive to be with them as it is a fairly large group that still had many cardiac fatalities. It was shown that if they fell in this intermediate Framingham range, but had a high calcium score, they were at higher risk than those in the same Framingham range with a low calcium score. It would be beneficial to have a coronary artery calcium score done on those individuals with a Framingham score of 10% to 19% likelihood in ten years.

More studies are necessary in order to confirm these findings.

Reference:
Framingham Score and Coronary Artery Calcium Score, diagnosisheart.com

Who should consider having a cardiac score exam? Talk to your doctor or cardiologist for their recommendation -

It is recommended that cardiac scoring be obtained for those with 3 or more of these risk factors:

• age (women over 55 and men over 45)
• high cholesterol
• history of smoking
• high blood pressure (hypertension)
• diabetes
• family history of heart disease
• obesity