Interpreting the Coronary Artery Calcium Score - Critical Information for the Practicing Physician.

Coronary artery calcium scanning is a routine test for assessing the severity of atherosclerosis in asymptomatic individuals. This inexpensive, noninvasive test quantifies the calcium deposition in the 4 principal coronary arteries. Correct interpretation is important to the physician (for recommending therapy) and to the patient (for determining his or her lifetime risk of a cardiovascular event). A score of 0 indicates that a cardiovascular event is extremely unlikely in the next 5 years. In contrast, a score greater than 0 portends a coronary event. The higher the score, the greater the risk. Both the arterial location of the calcium and the number of coronary arteries involved alter the interpretation of the calcium score. At any given age, females have significantly lower scores than males. One-third of individuals with scores greater than 1000 will have a cardiovascular event within 3 years. For all elevated calcium scores, aggressive treatment is warranted, including significant lifestyle changes and medications to reduce low-density lipoprotein cholesterol. Understanding the importance of the coronary artery calcium score will result in improved therapy and patient compliance.

Money management, patient safety and customer service among top concerns for physician executives. Interview by Barbara Linney.

Find out what's happening today and what the future may be like for physician executives. Seasoned physician executives and well-known physician executive recruiters share their insights on the profession.

Evidence for recent increases in obesity and non-insulin-dependent diabetes mellitus in a Navajo community.

Historic and current biomedical data were used to quantify changes in obesity and non-insulin-dependent diabetes mellitus (NIDDM) over a 30 year period in a Navajo community. Medical charts from an earlier study (1955-1961) provided data on 827 adults. Field-based methods yielded data from 231 adults during a health survey in 1988. The adjusted prevalence of overweight (body mass index ≥27.8 males, ≥27.3 females) has increased from 18.9% to 43.7% (P = .0001) and the adjusted prevalence of NIDDM has increased from 1.2%-12.4% (P = .0001) in the community. Current members of the community have twice the risk of being diabetic or overweight than the U.S. general population. The recent and dramatic increases in these health conditions demonstrate the effect of an important environmental component which requires further investigation. © 1992 Wiley-Liss, Inc.

The relationship of body fat distribution to non-insulin-dependent diabetes mellitus in a Navajo community.

The relationship between non-insulin-dependent diabetes mellitus (NIDDM) and body fat distribution (BFD) as measured by waist/hip circumference (WHR) was investigated in a Navajo community. A sample of 136 females and 89 males, 20 years and older, was recruited using a cluster-sampling design. Fifty percent of the females and 30.3% of the males are overweight [body mass index (BMI) equivalent of >120% ideal body weight]. Prevalence of NIDDM is 14% in females and 10.1% in males. The sample is characterized by central BFD (mean WHR=0.897±0.075, females and mean WHR=0.963±0.071, males). WHR is significantly related to age and BMI in males (P < 0.05), but not in females. Adjusted odds ratios for risk of NIDDM prevalence with increasing WHR category were estimated from a multiple logistic regression model which controlled for age and BMI. The odds ratio and 95% confidence interval (95% CI) is 2.19 (1.14, 4.19) for risk of NIDDM prevalence for a female in the middle BFD category compared to a female in the low BFD category. Risk increases to 3.63 (95% CI=1.25, 10.52) for a female in the highest BFD category. Although there is an increased risk of NIDDM prevalence with central BFD for males, it is not statistically significant. Preferential energy storage in abdominal fat depots may be a phenotypic expression of the "Thrifty Genotype," which places American Indians at greater risk for metabolic disorders.