Risk refinement, reclassification, and treatment thresholds in primary prevention of cardiovascular disease: incremental progress but significant gaps remain.

摘要

THE STUDY BY POLONSKY ET AL ADDS INFOR-mation to the debate about the potential role of screening for coronary artery calcification (CAC) in asymptomatic populations. This well-designed prospective cohort study showed that the additional information of CAC may help to refine risk assessment in a way that more accurately distributes segments of the study population into risk categories with possible therapeutic implications. This was illustrated quantitatively by using a method called net reclassification index. In other words, the addition of a CAC score altered conventional risk determination (Framingham Risk Score [FRS]) such diat the post-test probability could reclassify a patient to a new category of risk.