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Rationale and design of a trial to personalize risk assessment in familial coronary artery disease

Marwick, TH, Whitmore, K, Nicholls, SJ, Stanton, T, Mitchell, G, Tonkin, A, Blizzard, C ORCID: 0000-0002-9541-6943, Neil, A ORCID: 0000-0002-1344-6672, Jones, C and Watts, GF 2018 , 'Rationale and design of a trial to personalize risk assessment in familial coronary artery disease' , American Heart Journal, vol. 199 , pp. 22-30 , doi: 10.1016/j.ahj.2017.09.011.

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Abstract

Background: The lifetime risk of coronary artery disease (CAD) is doubled in people with a family history of prematuredisease, yet this risk is not captured in most 5- or 10-year risk assessment algorithms. Coronary artery calcium scoring (CCS) isa marker of subclinical CAD risk, which has been shown in observational studies to provide prognostic information that isincremental to clinical assessment; is relatively inexpensive; and is performed with a small radiation dose. However, the use ofCCS in guiding prevention is not strongly supported by guidelines. Showing definitive evidence of the efficacy and costeffectivenessof CCS is therefore of importance.Study design: The proposed randomized controlled trial of the use of CCS will be targeted to 40- to 70-year-old firstdegreerelatives of patients with CAD onset b60 years old or second-degree relatives of patients with onset b50 years old.Control patients will undergo standard risk scoring and be blinded to CCS results. In the intervention group, primary preventionin patients undergoing CCS will be informed by this score. At 3 years, effectiveness will be assessed on change in plaquevolume at computed tomography coronary angiography, the extent of which has been strongly linked to outcome.Summary: The CAUGHT-CAD trial will provide evidence to inform the guidelines regarding the place of CCS in decisionmaking regarding primary prevention of patients with a family history of premature disease.

Item Type: Article
Authors/Creators:Marwick, TH and Whitmore, K and Nicholls, SJ and Stanton, T and Mitchell, G and Tonkin, A and Blizzard, C and Neil, A and Jones, C and Watts, GF
Keywords: coronary artery disease, risk assessment, family history, coronary artery calcium scoring, trial design
Journal or Publication Title: American Heart Journal
Publisher: Mosby
ISSN: 0002-8703
DOI / ID Number: 10.1016/j.ahj.2017.09.011
Copyright Information:

© 2017 Elsevier Inc. All rights reserved.

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