Coronary risk stratification: from PREVEND to the prevention of coronary events

The aim of the thesis was to evaluate some of the unresolved issues on the pathway from risk association to risk stratification with regard to C-reactive protein, urinary albumin excretion and coronary calcium. This thesis shows that C-reactive protein is associated to angiographic evidence of coronary artery disease as well as clinical outcome, accounts for a large proportion of coronary risk, may improve the prediction of coronary events and has the potential to change clinical management. With regard to urinary albumin excretion, these associations were less conclusive for angiograpic evidence of coronary artery disease, the prediction of coronary events and change in clinical management. Nevertheless, urinary albumin excretion in combination with the metabolic syndrome identifies subjects who benefit from statin treatment. With regard to coronary calcium, levels of coronary calcifications were associated with angiographic evidence of coronary artery disease. Furthermore, measurement of coronary calcium by electron beam computed tomography is an appropriate alternative for exercise testing for coronary risk stratification in subjects at increased coronary risk, and may result in a change in clinical management.