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Framingham risk scores should not be used in isolation to prescribe statins to patients

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Traditional Framingham risk assessment scores for coronary atherosclerosis should not be used in isolation to decide prescribe statin drug therapy to patients, according to a study.

Findings from the US study of 1,653 patients found that coronary risk stratification using only Framingham risk factors is a weak predictor for atherosclerotic plaques in individual patients.

Patients with little or no plaque might be prescribed unnecessary statin drug therapy for life, while others with substantial plaques might be undertreated or receive no treatment at all.

Overall, 21% of patients would have their statin prescription changed had they been assessed using CT angiography instead of Framingham and 26% of patients on statins had no detectable plaque.

Authors wrote: ‘More than a quarter of patients on statins had no detectable plaque but were already on drug therapy for life and others were on no therapy despite plaque burdens as high as or higher than the median for patients with known coronary atherosclerosis.

‘Coronary CTA may provide incremental information beyond risk factors and may significantly influence therapeutic decisions regarding prophylactic therapy for CAD.’

American Journal of Roentgenology (2009) 192:235-243

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