Author + information
- Received August 26, 2019
- Revision received November 12, 2019
- Accepted December 9, 2019
- Published online January 15, 2020.
- Michael J. Blaha, MD, MPHa,b,∗ (, )@MichaelJBlaha,
- Seamus P. Whelton, MD, MPHa,
- Mahmoud Al Rifai, MD, MPHa,c,
- Zeina Dardari, MSa,
- Leslee J. Shaw, PhDd,
- Mouaz H. Al-Mallah, MDe,
- Kunihiro Matsushita, MD, PhDb,f,g,
- Alan Rozanski, MDh,
- John A. Rumberger, MDi,
- Daniel S. Berman, MDj,
- Matthew J. Budoff, MDk,
- Michael D. Miedema, MD, MPHl,
- Khurram Nasir, MD, MPH, MSca,m and
- Miguel Cainzos-Achirica, MD, MPH, PhDa
- aDivision of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
- bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- cSection of Cardiology, Baylor College of Medicine, Houston, Texas
- dWeill Cornell Medical College, New York, New York
- eDivision of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
- fDepartment of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- gDepartment of Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- hDivision of Cardiology, Mount Sinai St. Luke’s Hospital, New York, New York
- iPrinceton Longevity Center, Princeton, New Jersey
- jDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
- kDepartment of Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- lMinneapolis Heart Institute and Foundation, Minneapolis, Minneapolis
- mCenter for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Michael J. Blaha, Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins Hospital, Blalock 524D1, 600 N. Wolfe Street, Baltimore, Maryland 21287.
Objectives This study compared risk discrimination for the prediction of coronary heart disease (CHD) and cardiovascular disease (CVD) deaths for the Pooled Cohort Equations (PCE), the MESA (Multi-Ethnic Study of Atherosclerosis) Risk Score (with and without coronary artery calcium [CAC]), and of simple addition of CAC to the PCE.
Background The PCE predict 10-year risk of atherosclerotic CVD events, and the MESA Risk Score predicts risk of CHD. Their comparative performance for the prediction of fatal events is poorly understood.
Methods We evaluated 53,487 patients ages 45 to 79 years from the CAC Consortium, a retrospective cohort study of asymptomatic individuals referred for clinical CAC scoring. Risk discrimination was measured using C-statistics.
Results Mean age was 57 years, 35% were women, and 39% had CAC of 0. There were 421 CHD and 775 CVD deaths over a mean 12-year follow-up. In the overall study population, discrimination with the MESA Risk Score with CAC and the PCE was almost identical for both outcomes (C-statistics: 0.80 and 0.79 for CHD death, 0.77 and 0.78 for CVD death, respectively). Addition of CAC to the PCE improved risk discrimination, yielding the largest C-statistics. The MESA Risk Score with CAC and the PCE plus CAC showed the best discrimination among the 45% of patients with 5% to 20% estimated risk. Secondary analyses by estimated CVD risk strata showed modestly improved risk discrimination with CAC also among low- and high-estimated risk groups.
Conclusions Our findings support the current guideline recommendation to use, among available risk scores, the PCE for initial risk assessment and to use CAC for further risk assessment in a broad borderline and intermediate risk group. Also, in select individuals at low or high estimated risk, CAC modestly improved discrimination. Studies in unselected populations will lead to further understanding of the potential value of tools combining risk scores and CAC for optimal risk assessment.
Dr. Blaha was supported by National Institutes of Health award L30 HL110027 for this project. Dr. Budoff has received grant support from General Electric. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 26, 2019.
- Revision received November 12, 2019.
- Accepted December 9, 2019.
- 2020 American College of Cardiology Foundation
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