It has previously been suggested that individuals classified at intermediate cardiovascular disease (CVD) risk could benefit from the measurement of other risk factors/markers such as coronary artery calcification (CAC) and/or C-reactive protein (CRP) in order to properly assess CVD risk. Out of 4,345 participants aged 45-75 years of the Heinz Nixdorf Recall Study, 280 had prevalent coronary artery disease (CAD). In univariate analyses performed in men, CAC showed the highest associations with CAD risk in men with either high or low CRP levels (rate ratio, RR=18.2, 95% CI, 10.6-31.3). In women, CAC also showed the highest association with CAD but only among those with CRP levels above the median value (RR=11.0, 95% CI, 5.1-23.6). Based on the National Cholesterol Education Program-Adult Treatment Panel III guidelines, a metabolic syndrome score was developed and participants were classified into low (20%) risk categories. When both CAC and CRP were added to the metabolic syndrome in men, 21% of men initially classified at intermediate risk were reclassified into the high-risk category and 52% were reclassified into the low-risk category. In women, 25% were reclassified into the high-risk category and 47% were reclassified into the low-risk category. These results suggest that assessment of either CAC or CRP could provide a better estimate of CAD risk in patients classified at intermediate risk by the metabolic syndrome.
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