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July 26, 2017JAMA Cardiology

CAC score predicts incident CHD better than age in older adults without known CVD.

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Why the study?

Does coronary artery calcium (CAC) scoring improve prediction of incident ASCVD events compared to age in adults older than 60 years without known ASCVD?

Population

9,768 adults older than 60 years without known ASCVD at baseline. US cohort: mean age 70.1 years, 54.0%…

Comparison

Coronary artery calcium scoring using cardiac… vs Age

Design

Cohort

Follow-up

11 years

Key result

Coronary artery calcium score provided better discrimination for incident coronary heart disease than age (C statistic difference 0.043) in older adults without known cardiovascular disease.

Authors

YYYuichiro YanoCOChristopher J. O’DonnellLKLewis H. Kuller

Discussion

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Overview

May enhance CHD risk stratification over age alone in older adults without known CVD; extends observational data but leaves clinical adoption open.

Study Design

Type

Cohort (n=4,778)

Multicenter

Yes

Structured PICO

Does coronary artery calcium (CAC) scoring improve prediction of incident ASCVD events compared to age in adults older than 60 years without known ASCVD?

P
Population
9,768 adults older than 60 years without known ASCVD at baseline (4,778 from 3 US cohorts, 4,990 from 2 European cohorts). US cohort: mean age 70.1 years, 54.0% women, 50.9% nonwhite.
I
Intervention
Coronary artery calcium (CAC) scoring using cardiac computed tomography
C
Comparator
Age (as a risk predictor in cardiovascular risk models)
O
Outcome
Incident ASCVD events including coronary heart disease (CHD) and stroke over 11 years of follow-uphard clinical

Main Result

Effect estimate: C statistics difference 0.043 (95% CI 0.009-0.075)

Absolute Event Rate: 0.733% vs 0.69%

Coronary artery calcium scoring provides better discrimination of incident coronary heart disease risk than age alone in older adults without known ASCVD.

Limitations

  • Participants receiving statins were included, and CAC score was reported to participants and physicians, potentially leading to risk factor modification and underestimation of risk.
  • Assessments of CAC score, cardiovascular risk factors, and outcomes were relatively similar but not identical across cohorts.
  • Limited age distribution in the study populations might affect risk reclassification differences.
  • Cannot address cost-effectiveness, access, utility, and integration in shared decision-making.

Cite This Study

Yano et al. (2017) conducted a cohort in Atherosclerotic cardiovascular disease (n=4,778). Coronary artery calcium score vs. Age was evaluated on Incident coronary heart disease prediction (C statistic) (C statistics difference 0.043, 95% CI 0.009-0.075). Coronary artery calcium score provided better discrimination for incident coronary heart disease than age (C statistic difference 0.043) in older adults without known cardiovascular disease.

synapsesocial.com/papers/6a0f2c095f469783126c9d47https://doi.org/10.1001/jamacardio.2017.2498
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