Comparison of coronary artery calcification scores and National Cholesterol Education Program guidelines for coronary heart disease risk assessment and treatment paradigms in individuals with chronic traumatic spinal cord injury

Abstract

Objective: To investigate the risk of coronary heart disease (CHD) in individuals with spinal cord injury (SCI) according to the National Cholesterol Educational Program (NCEP) guidelines and CT coronary artery calcium scores (CCS).Research: Cross-sectional study of consecutive sample of males with SCI presenting to a single site for CHD risk assessment.Participants/methods: Males age 45-70 with traumatic SCI (American Spinal Injury Association (ASIA) A, B, and C) injured for at least 10 years with no prior history of clinical CHD.Medical history, blood-pressure, and fasting lipid panel were used to calculate risk for CHD with the use of the Framingham risk score (FRS).Risk and treatment eligibility status was assessed based on NCEP/FRS recommendations and by presence and amount of CCS.Percent agreement (PA) and kappa were calculated between the two algorithms.Spearman correlations were calculated between CCS and FRS and individual risk factors.Results: A total of 38 men were assessed; 18 (47.4%)had CCS > 0. The PA between NCEP/FRS assessment and CCS was 18% with a kappa of -0.03.11 (28.9%) had CCS > 100 or >75th percentile for their age, sex, and race, which might qualify them for lipid-lowering treatment.Only 26 were placed into the same treatment category by NCEP/FRS and CCS, for a PA of 68% with a kappa of 0.35.In all, 20 (52.6%) were eligible for lipid-lowering treatment by either NCEP/FRS (n = 9) or CCS (n = 11).Seven subjects were above the treatment threshold based on CCS, but not NCEP/FRS and five subjects were above the NCEP/FRS threshold, but not CCS.Just four subjects were eligible by both algorithms.CCS only correlated with FRS (r = 0.508, P = 0.001) and age (r = 0.679, P < 0.001).