Key result
Coronary age incorporating coronary artery calcium demonstrated excellent risk discrimination for incident coronary heart disease (C-statistic 0.76), matching the predictive ability of the MESA CHD Risk Score and outperforming chronological age.
Why the study?
The optimal method for communicating coronary heart disease risk to individual patients is not yet clear.
Does a coronary age calculator derived from the MESA CHD Risk Score and CAC provide accurate risk discrimination for incident CHD events compared to chronological age and traditional risk scores?
Cohort (n=6,727)
Yes
Does a coronary age calculator derived from the MESA CHD Risk Score and CAC provide accurate risk discrimination for incident CHD events compared to chronological age and traditional risk scores?
A newly derived coronary age calculator incorporating traditional risk factors and CAC provides a convenient, easy-to-communicate metric that retains the excellent risk discrimination of the MESA CHD Risk Score.
Background The optimal method for communicating coronary heart disease (CHD) risk to individual patients is not yet clear. Recent research supports the concept of "coronary age" for more effective risk communication. We defined an individual's coronary age as the age at which an average healthy individual would have an equivalent estimated CHD risk as that calculated for the index individual, building on our previously validated MESA (Multi-Ethnic Study of Atherosclerosis) 10-year CHD Risk Score equations with and without coronary artery calcium (CAC). Methods and Results We derived a coronary age by (1) calculating the MESA 10-year CHD risk; (2) mathematically setting this equal to an equation describing risk of an average healthy MESA participant, as a function of age; and (3) solving for age. The risk discrimination of the resultant coronary age was compared with that of chronological age, the MESA CHD Risk Score, and CAC alone. Approximately 95% of coronary age values ranged from 30 years less to 30 years higher than chronological age. Although the mean chronological age of individuals experiencing CHD events compared with those free of events was 67.4 versus 61.8 years, the difference in coronary age including CAC was larger (80.6 versus 62.8 years). Coronary age with CAC had identical predictive ability to that of MESA CHD Risk Score and outperformed chronological age and CAC alone. Conclusions The newly derived coronary age is a convenient transformation of MESA CHD Risk, retaining very good risk discrimination. This easy-to-communicate tool will be available for patients and clinicians, potentially facilitating risk communication in routine care.
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Blaha et al. (2021) conducted a cohort in Coronary heart disease risk prediction (n=6,727). Coronary age calculator (with and without coronary artery calcium) vs. Chronological age and MESA CHD Risk Score was evaluated on Incident coronary heart disease (CHD) events (C-statistic 0.76). Coronary age incorporating coronary artery calcium demonstrated excellent risk discrimination for incident coronary heart disease (C-statistic 0.76), matching the predictive ability of the MESA CHD Risk Score and outperforming chronological age.
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