Coronary artery calcium score improved cardiovascular risk prediction in subjects with CKD more than carotid intima-media thickness or ankle-brachial index (HR 1.69; 95% CI 1.45-1.97 per 1 SD).
Cohort (n=6,553)
Does the inclusion of coronary artery calcium score improve cardiovascular risk prediction beyond traditional Framingham predictors in individuals with CKD?
Coronary artery calcium score provides the greatest improvement in cardiovascular risk prediction beyond traditional risk factors in patients with chronic kidney disease compared to carotid intima-media thickness or ankle-brachial index.
Effect estimate: HR 1.69 (95% CI 1.45-1.97)
Whether inclusion of the coronary artery calcium score improves cardiovascular risk prediction in individuals with CKD, a population with unique calcium-phosphate homeostasis, is unknown. Among 6553 participants ages 45-84 years without prior cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis, coronary artery calcium score was assessed for cardiovascular risk prediction beyond the Framingham predictors in those with (n=1284) and without CKD and contrasted with carotid intima-media thickness and ankle-brachial index (two other measures of subclinical atherosclerosis). During a median follow-up of 8.4 years, 650 cardiovascular events (coronary heart disease, stroke, heart failure, and peripheral artery disease) occurred (236 events in subjects with CKD). In Cox proportional hazards models adjusted for Framingham predictors, each subclinical measure was independently associated with cardiovascular outcomes, with larger adjusted hazard ratios (HRs; per 1 SD) for coronary artery calcium score than carotid intima-media thickness or ankle-brachial index in subjects without and with CKD (HR, 1.69; 95% confidence interval 95% CI, 1.45 to 1.97 versus HR, 1.12; 95% CI, 1.00 to 1.25 and HR, 1.20; 95% CI, 1.08 to 1.32, respectively). Compared with inclusion of carotid intima-media thickness or ankle-brachial index, inclusion of the coronary artery calcium score led to greater increases in C statistic for predicting cardiovascular disease and net reclassification improvement. Coronary artery calcium score performed best for the prediction of coronary heart disease and heart failure, regardless of CKD status. In conclusion, each measure improved cardiovascular risk prediction in subjects with CKD, with the greatest improvement observed with coronary artery calcium score.
Matsushita et al. (Fri,) conducted a cohort in Chronic Kidney Disease (n=6,553). Coronary artery calcium score vs. Carotid intima-media thickness and ankle-brachial index was evaluated on Cardiovascular events (coronary heart disease, stroke, heart failure, and peripheral artery disease) (HR 1.69, 95% CI 1.45-1.97). Coronary artery calcium score improved cardiovascular risk prediction in subjects with CKD more than carotid intima-media thickness or ankle-brachial index (HR 1.69; 95% CI 1.45-1.97 per 1 SD).