We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Coronary Heart Disease Risk Assessment by Traditional Risk Factors and Newer Subclinical Disease Imaging Is a “One-Size-Fits-All” Approach the Best Option?

Sarah Rosner Preis, ScD, MPH; Christopher J. O’Donnell, MD, MPH
Arch Intern Med. 2007;167(22):2399-2401. doi:10.1001/archinte.167.22.2399.
Text Size: A A A
Published online


Coronary heart disease (CHD) and other atherosclerotic cardiovascular diseases (CVDs) remain the leading cause of death and disability in women as well as men in the Western and developing world.1 Clinical CHD, manifested as angina or an acute coronary syndrome, results from thrombosis in an unstable atherosclerotic plaque in the coronary arteries.2 Clinicians and researchers alike are keenly interested in the identification of optimal methods for prediction of CHD risk. Thus, it is not surprising that there is great interest in direct imaging of the heart for the presence and extent of coronary artery atherosclerosis detected by cardiac computed tomography (CT). Multiple studies of tens of thousands of patients referred for cardiac CT measurement of coronary artery calcium (CAC) provide consistent evidence that the presence and extent of CAC predicts strongly increased risks for CHD.3 However, much of the evidence for CAC is derived from middle-aged and older referral populations, usually including more men than women,4 and only a few recent studies have been conducted in unbiased, community-based populations.5,6 Moreover, while CAC increases markedly with age and is more prevalent in younger men than in women, prospective studies of CAC for risk prediction have largely used a one-size-fits-all definition of CAC scores for low vs high levels of CAC (eg, Agatston score of 400) rather than an age- and sex-standardized scoring system. Current guidelines suggest that there may be a role for CAC screening but do not yet recommend full implementation in practice.4,7 Findings from an interesting study published in this issue of the Archives highlight the need for better levels of evidence for women and other understudied populations.8

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference

Users' Guides to the Medical Literature
Clarifying Your Question