Abstract P370: Utility of Cardiovascular Risk Algorithms in Prediction of Subclinical Atherosclerosis in the Young

Background: Prediction of cardiovascular risk in younger patients is particularly challenging. Most current risk estimators underestimate risk potentially leading to under-treatment in younger patients with significant risk factors for atherosclerosis. Methods: A retrospective analysis of patients age 20 to 50 (n = 274) referred to a cardiology clinic between 2013 and 2016 and undergoing carotid ultrasound for risk stratification and statin initiation was conducted. A medical history was obtained by chart review at the time of carotid ultrasound. The 2008 Framingham general risk score was used to calculate a 10-year cardiac risk. Carotid plaque was defined using standard definitions as carotid artery focal wall thickening 50% or greater than the surrounding vessel wall or a focal region > 1.5 mm protruding into the lumen. Results: Average age was 41 ± 7.9 years, 60% male, 77% Caucasian, 4% diabetes. Ten percent (n = 27) had carotid plaque noted on ultrasound. Those with plaque compared to those without were older (46 ± 4.3 vs. 41 ± 7.5, p 160 mg/dl, DMII or HTN). This compared to 37% (n=10) who had carotid plaque on imaging and a risk score ≥ 7.5%. Receiver operator curve characteristics to predict plaque were similar for the cardiac risk score (AUC 0.674) and number of cardiac risk factors (AUC 0.674, p = 0.96). Conclusion: In patients 50 years or younger, ≥ 2 cardiac risk factors revealed a higher percentage of carotid plaque than a Framingham cardiac risk score cut off value of ≥ 7.5%. In younger patients with cardiac risk factors, novel algorithms are needed to more accurately guide medication therapy.