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1、©2003-2006,DavidStultz,MD©2003-2006,DavidStultz,MDCoronaryCalciumScoringMythorReality?DavidStultz,MDMay17,2006CardiologyFellow,PGY-6©2003-2006,DavidStultz,MD©2003-2006,DavidStultz,MDLeadingcausesandcontributionsofdeathintheUSA(2000)BraunwaldAtlasofInternalMedicine©2003-2006,TDavhidSetultz,aMDthe
2、roscleroticprocess(A)BraunwaldAtlasofInternalMedicine©2003-2006,DavidStultz,MDTheatheroscleroticprocess(B)BraunwaldAtlasofInternalMedicine©2003-2006,DavidStultz,MDPlaquedevelopmentandlocalizationBraunwaldAtlasofInternalMedicine©2003-2006,DavidStultz,MDDifferencesinconsistencyandrupturevulnerabil
3、ityofcoronaryplaques(A)BraunwaldAtlasofInternalMedicine©2003-2006,DavidStultz,MDFraminghamRiskScore•EstimatesoftotalCHDrisk(riskofdevelopingoneofthefollowing)overthecourseof10years–anginapectoris–myocardialinfarction–coronarydiseasedeath•Separatescoresheetsareusedformenandwomen•Factorsusedtoesti
4、materisk–Age–bloodcholesterol(orLDLcholesterol)–HDLcholesterol–bloodpressure–cigarettesmoking–diabetesmellitus•RelativeriskforCHDisestimatedbycomparisontolowriskFraminghamparticipantsWilsonPWF,D'AgostinoRB,LevyD,BelangerAM,SilbershatzH,KannelWB.Predictionofcoronaryheartdiseaseusingriskfactorcate
5、gories.Circulation1998;97:1837-1847.©2003-2006,DavidStultz,MDUsersofthisriskalgorithmshouldbeawareofseveralcaveats:1.…onlyforpersonswithoutknownheartdisease.2.…onlycoronaryheartdisease,nototherheartandvasculardiseases.3.…almostallCaucasian.TheFraminghamriskalgorithmmaynotfitotherpopulationsquite
6、aswell.4.Forsomeofthesex-agegroups…eventsarequitesmall.Therefore,theestimatesofriskforthosegroupsmaylackprecision.5.OtherorganizationsareconsideringhowtheinformationfromtheFraminghamriskalgorithm,aswellasotherassessmentsofrisk,mightbestbeincorporatedintoclinicalpractice.6.…estimatestheriskofdeve
7、lopingCHDwithina10-yeartimeperiod.Thisriskscoremaynotadequatelyreflectthelong-termorlifetimeCHDriskofyoungadults,whichis:oneintwoformenandoneinthreeforwomen.7.ThepresenceofanyCHDriskfactorrequiresappropriateattentionbecausea
