Patients with acute coronary syndromes (ACS) have a poor short- and long-term prognosis. We sought to examine the presence of established coronary risk factors in contemporary patients presenting with an ACS for the first time and no known coronary artery disease (CAD) in the past. The study was conducted in 3171 consecutive patients admitted with the diagnosis of ACS. Of these, 941 patients (30%) had the admission as the first occurrence of ACS and no prior history of CAD. We studied the degree to which these first presenters with ACS had 1 or more established risk factors. We found that 98% of patients presenting with an ACS for the first time and no previous CAD had at least 1 established risk factor. Current population-based screening efforts must be improved to allow more effective prevention strategies and more individualized risk prediction.
Thom T., Haase N., Rosamond W., et al, American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Heart disease and stroke statistics-2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation . 2006;113(6):e85-e151.
Centers for Disease Control and Prevention (CDC).State-specific mortality from sudden cardiac death- United States, 1999. MMWR Morb Mortal Wkly Rep.2002;51(6):123-126.
4.
Napoli C., Glass C., Witztum J., Deutsch R., D’Armiento F., Palinsk W.Influence of maternal hypercholesterolemia during pregnancy on progression of early atherosclerotic lesions in childhood: Fate of Early Lesions in Children (FELIC) study. Lancet. 1999;354(9186):1234-1241.
5.
Heart Protection Study Collaborative Group.MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet. 2002;360(9326):7-22.
6.
Shepherd J. , Cobbe S.M., Ford I., et al. West of Scotland coronary prevention study group: prevention of coronary heart disease with pravastatin in men with hypercholesterolemia . N Engl J Med. 1995;333(20):1301-1307.
7.
Downs JR, Clearfield M., Weis S., et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/ TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention study. JAMA. 1998;279(20):1615-1622.
8.
Sever PS, Dahlof B., Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower than average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized control trial. Lancet. 2003;361: 1149-1158.
9.
Saito I., Folsom AR, Brancati FL, Duncan BB, Chambless LE, McGovern PGNon-traditional risk factors for coronary heart disease incidence among persons with diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Ann Intern Med. 2000;133(2):81-91.
10.
Fye WBCardiology workforce: there’s already a shortage, and it’s getting worse. J Am Coll Cardiol. 2002; 39(12):2077-2079.
11.
Hennekens CHIncreasing burden of cardiovascular disease: current knowledge and future directions for research on risk factors. Circulation. 1998;97(11):1095-1102.
12.
Prasad A., Zhu J., Halcox JP, Waclawiw MA, Epstein SE, Quyyumi AAPredisposition to atherosclerosis by infections: role of endothelial dysfunction . Circulation. 2002;106(2):184-190.
13.
Tavazzi L.Clinical epidemiology of acute myocardial infarction. Am Heart J. 1999;138(2 pt 2):S48-S54.
14.
Mackay J., Mensah G.The Atlas of Heart Disease and Stroke. World Health Organization and US Centers for Disease Control and Prevention ; The Hanaway Press, London2004.
15.
Yusuf S., Hawken S., Ounpuu S., et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952.
16.
Stamler J., Stamler R., Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999;282(21):2012-2018.
17.
Khot U., Khot M., Bajzer C., Ellis S., Topol E.Prevalence of conventional risk factors in patients with coronary heart disease . JAMA. 2003;290(7):898-904.
18.
Rockville M.The Health Benefits of Smoking Cessation: A Report of the Surgeon General . US Dept of Health and Human Services; DHHS publication (CDC) Rockville, Md.; 1990: 90-8416.
19.
Stamler J., Vaccaro O., Neaton JD, Wentworth D.Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care . 1993;16(2):434-444.
20.
Verschuren WM, Jacobs DR, Bloemberg BP, et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures: twenty-five-year follow-up of the seven countries study. JAMA. 1995; 274(2):131-136.
21.
MacMahon S. , Peto R., Cutler J., et al. Blood pressure, stroke, and coronary heart disease, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias . Lancet . 1990;335(8692):765-774.
22.
Liberopoulos EN, Daskalopoulou SS, Mikhailidis DPEarly statin therapy in patients with acute coronary syndrome. Hellenic J Cardiol . 2005 ;46(1):5-8.
23.
Paraskevas KI, Bessias N., Papas TT, Gekas CD, Andrikopoulos V., Mikhailidis DPDo different vascular risk factors affect all arteries equally?Angiology . 2008; 59(4):397-401.
24.
Young LH, Chyun DAHeart disease in patients with diabetes. Ellenberg and Rifkin’s Diabetes Mellitus: Theory and Practice. By Daniel Porte, Robert S. Sherwin, Alain Baron, Max Ellenberg, Harold Rifkin Edition: 6 braille, illustrated. Published by McGraw-Hill Professional, 2002 ;vol 6:823-844.
25.
Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI). Circulation. 1997;96(6):1761-1769.
26.
Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status. J Am Coll Cardiol.2000;35(5):1122-1129.
27.
Wackers FT, Young L., Inzucchi SE, et al, Detection of Ischemia in Asymptomatic Diabetics Investigators. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care. 2004;27(8):1954-1961.
28.
Faglia E., Manuela M., Antonella Q., et al. Risk reduction of cardiac events by screening of unknown asymptomatic coronary artery disease in subjects with type 2 diabetes mellitus at high cardiovascular risk: an open-label randomized pilot study. Am Heart J. 2005; 149(2):1-6.
29.
D’Agostino RB Sr, Grundy S., Sullivan LM, Wilson P.CHD Risk Prediction Group.Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic group’s investigation. JAMA. 2001; 286(2):180-187.
30.
Danesh J., Wheeler JG, Hirschfield GM, et al. C reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med.2004;350(14):1387-1397.
31.
Cooper JA, Miller GJ, Humphries SEA comparison of the PROCAM and Framingham point-scoring systems for estimation of individual risk of coronary heart disease in the Second Northwick Park Heart Study. Atherosclerosis. 2005;181(1):93-100.
32.
Liu J., Hong Y., D’Agostino RB Sr , et al. Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA. 2004;291(21): 2591-2599.
33.
Arad Y., Goodman KJ, Roth M., Newstein D., Guerci ADCoronary calcification, coronary disease risk factors, C reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol. 2005;46(1):158-165.
34.
Grundy SMThe changing face of cardiovascular risk. J Am Coll Cardiol . 2005;46(1):173-175.
35.
De Backer G. , Ambrosioni E., Sechtem U., Silber S., Thomsen T., Wood D.Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2003;24(17):1601-1610.
36.
Wilson PW, D’Agostino RB, Levy D., Belanger AM, Silbershatz H., Kannel WBPrediction of coronary heart disease using risk factor categories . Circulation. 1998;97(18):1837-1847.
37.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19): 2486-2497.
38.
Greenland P. , Smith SC Jr, Grundy SMImproving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation . 2001;104(15):1863-1867.
39.
Taylor A., Merz N., Udelson J.Can atherosclerosis imaging techniques improve the detection of patients at risk for ischemic heart disease? Proceedings of the 34th Bethesda Conference. Bethesda, Maryland, USA. October 7, 2002. J Am Coll Cardiol.2003;41(11): 1856-1917.
40.
Anand D., Lim E., Raval U., Lipkin D., Lahiri A.Prevalence of silent myocardial ischemia in asymptomatic individuals with subclinical atherosclerosis detected by electron beam tomography. J Nucl Cardiol. 2004; 11(4):450-457.
41.
Raggi P., Callister TQ, Cooil B., et al. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation. 2000;101(8):850-855.
