10 20% 10-20% 10% 5. ( Framingham risk score; FRS ) ( )

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1 % -0% % 5 50% ( Framingham risk score; ( (1 ( ( ankle-brachial index ABI ABI 0.9 (1 ( Electron beam or multidetector computed tomography [ EBCT or MDCT ] ( coronary artery calcium score CASC 7 901

2 144 ( Coronary events ( Risk prognostication ( Emerging risk factors ( Subclinical atherosclerosis ( Electron beam computed tomography ( Multidetector computed tomography ( Coronary artery calcium score ( Coronary Heart Disease ( % ( total cholesterol; TC ( high density lipoprotein cholesterol; HDL-C 3 ( Framingham risk score; ( ( coronary heart disease event coronary event (sudden coronary death ( fatal myocardial infarction ( non-fatal myocardial infarction 3 ( American Heart Association; AHA ( primary prevention HA/ ( American College of Cardiology ACC ( secondary prevention 5 ( 3rd report of National Cholesterol Education Program Adult Treatment Panel NCEP-ATP III NCEP-ATP III 3 ( high ( intermediate ( low 4 A- 000 disease (1 ( NCEP-ATP III ( subclinical atherosclerosis C

3 HDL % 11 8% 0 1% 1 % 1 1% 13 1% 1% 14 1% 3 1% 15 0% 4 1% 1 5% 5 % 17 30% % 7 3% 8 4% 9 5% %

4 HDL % 0 11% 9 1% 1 14% 1% 17% 11 1% 3 % 1 1% 4 7% 13 % 5 30% 14 % 15 3% 1 4% 17 5% 18 % 19 8%

5 147 ( high-sensitivity C-reactive protein; hs-crp % (1 ( acute coronary syndrome (stable angina % 7,8 0% 9, ( ( peripheral artery disease; PAD ( 50% ( 3. remnant particles a subspecies Apo B Apo A-I /HDL C (homocysteine NCEP-ATP III (3 11 (4 NCEP-ATP III ( AHA ACC 34 Bethesda 14 SCORE ( ( Low Density Lipoprotein Cholesterol; LDL-C / statin LDL-C 1

6 PAD (1 ETT ETT (1 ( exercise treadmill test ETT ( ( ankle-brachial index; ABI 1 ABI ABI 0.9 PAD 50% ABI 90% 98% ABI PAD PAD CAPRIE PAD 1% % 0 PAD PAD.5-4-5% 1, 80% ABI % 40% 3 NCEP- ATP III PAD ABI ABI ( pretest probability 17 ETT ( ABI ABI ETT ( subclinical atherosclerotic plaque burden (1 ( electron beam computed tomography; EBCT ( multidetector computed tomography; MDCT ( coronary artery calcium score; ( ( carotid sonography

7 [ ] ( intima-media thickness; IMT (1 EBCT MDCT 5 5-8, CT CASC 75 Detrano Wong 37 ( Callister ( p< ( 43% 39,40 0, 50% 1% Mosca 400 % ( p=0.009 Keelan Raggi 33 3 CT 3 CAC ( 0 0.3% % % 50 8.% 90 1% Arad CT 19 = % = 0 5.5% = % = 80 14% ,43, ,47 IMT ( IMT hs-crp 5% 4 CT IMT 48,49 IMT hs- CRP AHA hs-crp

8 150 ( IIa 50 (b (c ( ( 400 (d hs-crp % AHA,41 50 / 1.0 / clopidogrel / 3.0 / ( I 41 ( 50 hs-crp ( IIa / 0% >40 > % 53, % LDL-C statin LDL LDL-C Statin LDL-C NCEP-ATP III (1 0% LDL 0 / LDL 130 / statin ( ( 0% 130 / LDL 130 / statin (3 % 130 / LDL 10 / statin (4 % / 190 / / (a ( HDL ( Coronary Artery Surgery Study % 59,0 CASS 5 40% 1 ( metabolic syndrome 005 AHA 88 ( ( 150 / ( 3 HDL 40 / 50 / ( ( 5 0 / ( 1

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12 154 New Advance in Risk Prognostication for Coronary Event Chih-Sen Kang, Ching-Iuan Chern, Mei-Shu Lin 1, Zhi-Yang Lai, Nen-Chung Chang, Chi-Sheng Chiou, and Tsung-Ming Lee 3 Department of Cardiology, Min-Sheng General Hospital, Taoyuan 1 Department of Pharmacy, National Taiwan University Hospital, Taipei Department of Internal Medicine, Taipei Medical University and Hospital, 3 Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan. According to 004 Report of Taiwan Area Main Causes of Death Statistics from the Department of Health, Taiwan; heart disease, the first time, substituted cerebrovascular disease as the second cause of deaths in Taiwan area. The majority of heart disease is coronary heart disease (CHD. Absolute risk of coronary event can be divided into three categories: high, intermediate, and lower risk with a -year risk for myocardial infarction (nonfatal + fatal and sudden death 0%, -0% and %, respectively. The absolute risk can be estimated by sum of Framingham risk score ( using the Framingham risk table. Patients at high risk are: clinical CHD, noncoronary forms of clinical atherosclerotic disease include those with peripheral arterial disease, abdominal aortic aneurysm, symptomatic and asymptomatic carotid artery disease with carotid narrowing 50 %, diabetes and high-risk patients estimated by who have no above clinical manifestation of atherosclerosis and diabetes. Many subjects will be found to be at intermediate-risk. Some of these patients will be reclassified as high risk because of associated emerging risk factors. Subclinical atherosclerotic disease is one of emerging risk factors. Subclinical atherosclerotic disease can be identified by non-imaging and imaging techniques. Non-imaging methods included: (1 Exercise treadmill testing (ETT identifies patients whose coronary atherosclerosis has advanced sufficiently to produce myocardial ischemia with exercise. Positive ETT identifies a high-risk patients; ( Ankle- brachial index (ABI detects peripheral artery disease (PAD. ABI < 0.9 indicates a PAD and the risk level can be raised to high-risk. Imaging methods are tests for detecting atherosclerotic plaque burden, included: (1 Electron beam or multidetector computed tomography can be used to identify coronary calcification, patients with intermediate risk plus a coronary artery calcium score ( > the 75th percentile for age and gender may be reclassified as high-risk. The exceedingly low coronary event rate in subjects with a <0 is consistent with angiographic studies indicating a comparably low likelihood of significant CAD, i.e., stenosis < 50% and an extremely low incidence of stress-induced myocardial ischemia (<1 % in such individuals. The increasing number of coronary events with an ever-increasing is also consistent with the dramatic increase in the incidence of stress-induced myocardial ischemia when are >0, and particularly >400; ( Carotid sonography, which measures the intima-media thickness could be used to elevate some patients with multiple risk factors to theto high-risk level. Risk factors for which interventions haveseveral interventions proved to lower risk of coronary events are as follows: lowering LDL-C reduces risk for coronary events and statins head the list of LDL-C lowering drugs. Goals of therapy are dependent on level of LDL-C and risk categories. Use of aspirin is dependent on risk level. Smoking cessation and physical activity are for all primary and secondary prevention. ( J Intern Med Taiwan 00; 17: