Are conventional cardiovascular risk scoring models predictive of coronary plaque progression?

Abstract Introduction Multiple cardiovascular (CV) risk assessment scores have been developed to guide treatment decisions and referrals for further testing. These tools were developed to predict CV events, but we are now in the position of using them to identify patients who might benefit from coronary plaque imaging. Their association with plaque burden and progression is unclear. Purpose To evaluate the association between conventional CV and atherosclerotic CV disease (ASCVD) risk assessment scores with coronary plaque burden and progression among asymptomatic individuals. Methods Asymptomatic individuals aged 40-70 years with a family history of coronary artery disease and not on statin therapy were recruited. Participants underwent computed tomography (CT) coronary angiography (CTCA) when coronary calcium score (CAC) was 0. Clinical characteristics and blood tests were assessed at baseline to calculate individuals’ CV and ASCVD risk scores. CTCA was repeated 3-year post baseline. Results Of 1060 participants (mean age 56±7 years, 53.6% female) who underwent CAC scoring, 499 (44.2%) had positive CAC scores. Among these, 365 participants completed both baseline and follow-up CTCA. The average baseline total lesion count was 3±2 with a total plaque volume of 116.3±113.9mm3. Spearman correlation between the Pooled Cohort Equation (PCE, mean score 6.9±5.1), the PREVENT 10-year ASCVD (mean score 3.6±2.0) and the Australian 10-year CVD (mean score 12.3±6.7) risk scores with total plaque volume at baseline were R=0.019, R=0.025 and R=0.018, respectively. For changes in plaque volume at 3-year follow-up, corresponding correlations for the three risk scores were R=-0.021, R=0.046 and R=-0.064. Multivariable linear regression analyses, adjusted for age, sex, statin prescription after baseline CTCA, cholesterol levels, diabetes and hypertension, showed that the Australian 10-year CVD risk scores had the strongest association with the changes in total plaque volume (β=-1.123 0.429, p=0.009). Conclusions The Australian 10-year CVD risk score best reflects coronary plaque progression over three years. However, none of these risk scores accurately reflect individuals’ coronary plaque characteristics at baseline, limiting their utility as screening tools to guide CAC/CTCA referral.