ABSTRACT
Although prevention strategies have resulted in marked declines in cardiovascular disease (CVD) mortality, women have not matched the 35-50% reductions noted for men.1-4 The third report from the National Cholesterol Education Program (NCEP) emphasizes using global risk scores or multifactorial risk assessment to identify intermediate-to high-risk individuals who will benefit from aggressive risk reduction programs.3 This method of targeting risk integrates multiple risk factors, such as age, gender, hypertension, smoking, and hyperlipidemia, into a 10-year estimate of coronary heart disease (CHD) death or nonfatal myocardial infarction (MI).5 The NCEP risk calculator is based upon data from the Framingham study cohort and defines low, intermediate, and high risk as 10-year event rates of <6%, 6-20%, and >20%.3 Data presented at the 34th Bethesda Conference on atherosclerotic imaging demonstrate that fewer women than men are categorized as intermediate to high risk, which is considered the optimal risk category for screening for subclinical disease.6,7
Recent reports further suggest that an alarmingly large number of women who are characterized as low risk have evidence of subclinical disease.8-11 Thus, standard risk factors account for a lower explanatory variation in outcome in women than men. Indeed, published literature suggests that, on average, only 60% of the variation in outcome in women can be explained using traditional cardiac risk factors (e.g. the Framingham risk score).8-12 Due to the disparity in risk factor prevalence and the associated prognosis, outcome estimation is challenging in women.
