GRUNDY
ET AL., Assessment of Cardiovascular Risk
J Am Coll Cardiol 1999;34:1348--59
AHA/ACC
Scientific Statement: Assessment of Cardiovascular Risk
by Use of Multiple-Risk-Factor Assessment Equations
A
Statement for Healthcare Professionals From the American
Heart Association and the American College of Cardiology
IV.
Definition of CHD
Interpretation
of risk estimates for CHD requires a precise definition
of CHD. Framingham estimates traditionally predict total
CHD, which includes angina pectoris, recognized and unrecognized
myocardial infarction, coronary insufficiency (unstable
angina), and CHD deaths. In contrast, many clinical trials1114
that have evaluated specific risk-reducing therapies have
specified major coronary events (recognized acute myocardial
infarction and CHD deaths) as the primary coronary end
points. In accord, the recent Framingham report2
also provided estimates for "hard" CHD, excluding angina
pectoris. The inclusion of coronary insufficiency (unstable
angina) and unrecognized myocardial infarction (defined
by electrocardiography) probably gives estimates of hard
CHD that are somewhat higher than combined end points
reported in several clinical trials.1114
A recent clinical trial, the Air Force/Texas Coronary
Artery Prevention Study (AFCAPS/TexCAPS),15
specified acute coronary events, including unstable angina,
acute myocardial infarction, and coronary death, as the
primary end point. This combined end point probably corresponds
closely to the Framingham study's definition of hard CHD.
Definitions of coronary end points assume critical importance
when risk cutpoints are defined to select patients for
specific therapies.
Copyright
© 2000 by The American Heart Association, Inc.
and
The American College of Cardiology
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