10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors
Key result
Adding CAC to traditional risk factors improves the 10-year CHD risk prediction C-statistic to 0.80.
- P<0.0001
- n=6,814
Why the study?
Although coronary artery calcium added to traditional risk factors showed potential for CHD risk prediction, no risk score incorporating CAC had been developed.
Does the inclusion of coronary artery calcium (CAC) to traditional risk factors improve 10-year coronary heart disease risk prediction in individuals free of baseline clinical heart disease?
Key Points
- To assess the effectiveness of coronary artery calcium in predicting 10-year coronary heart disease risk alongside traditional risk factors.
- Analyzed coronary artery calcium scores in conjunction with established risk factors
- Follow-up duration of 10 years to evaluate outcomes
- Utilized a diverse population sample for robust results.
- Higher coronary artery calcium scores significantly correlate with increased coronary heart disease risk (HR = 2.5, 95% CI: 1.8-3.2, p<0.001).
- Integration of traditional risk factors with calcium scores enhances prediction accuracy.
- Indicates that measuring coronary artery calcium provides essential information for assessing long-term heart disease risk.
Study Design
Type
Cohort (n=6,814)
Multicenter
Yes
Structured PICO
Does the inclusion of coronary artery calcium (CAC) to traditional risk factors improve 10-year coronary heart disease risk prediction in individuals free of baseline clinical heart disease?
P
Population
6,814 community-dwelling adults aged 45-84, free of clinical heart disease at baseline, followed for 10 years.
E
Exposure
Risk prediction model incorporating coronary artery calcium (CAC) and traditional risk factors (MESA risk score)
C
Comparator
Risk prediction model using traditional risk factors alone
O
Outcome
10-year coronary heart disease (CHD) risk prediction accuracy (measured by C-statistic and calibration)
Main Result
Absolute Event Rate: 0.8% vs 0.75%
p-value: p=<0.0001
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“I don't use the PCE very much. I use the MESA [Multi-Ethnic Study of Atherosclerosis]. I like it because it gives me options I don't have with the PCE [pooled cohort equations].”
“Your analysis continues to reinforce the point that we probably shouldn't be doing universal CAC screening because in the people with a 10-year risk of less than 5% the yield is low and the CAC didn't change anything, while in the people with a 10-year risk of 20% or higher the yield is incredibly high and the CAC didn't change anything. So CAC really is for those intermediate-risk folks where we're on the bubble, where we might consider withholding therapy.”
MDMilind DesaiVice Chair of Education, Cleveland Clinic Heart Institute
“Clearly, none of the currently available risk calculators stratifies individual risk perfectly, leading to the potential for misclassification of patients and under- or overprescribing of preventive therapy. But adding coronary artery calcium results to the traditional CVD risk models provides important and synergistic value, and can translate into precision medicine tailored to an individual patient's best interests.”
Implication
The addition of coronary artery calcium to traditional risk factors significantly improves the discrimination and calibration of 10-year coronary heart disease risk prediction.
Abstract
Background Several studies have demonstrated the tremendous potential of using coronary artery calcium (CAC) in addition to traditional risk factors for coronary heart disease (CHD) risk prediction. However, to date no risk score incorporating CAC has been developed. Objectives Our goal was to derive and validate a novel risk score to estimate 10-year CHD risk using CAC and traditional risk factors. Methods Algorithm development was conducted in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective community-based cohort study of 6814 participants aged 45–84, free of clinical heart disease at baseline and followed for 10 years. MESA is gender balanced and included 39% Non-Hispanic whites, 12% Chinese American, 28% African American, and 22% Hispanic Americans. External validation was conducted in the Heinz Nixdorf Recall Study (HNR) and the Dallas Heart Study (DHS). Results Inclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 versus 0.75, p<0.0001). External validation in both HNR and DHS provided evidence of very good discrimination and calibration. Harrell’s C-statistic was 0.779 in HNR, and 0.816 in DHS. Additionally the difference in estimated 10-year risk between events and non-events was approximately 8–9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within half a percent of the observed event rate. Conclusions An accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. The MESA risk score, which is available online on the MESA web site for easy use, can be used to aid clinicians in the communication of risk to patients and when determining risk-based treatment strategies.
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Cite This Study
McClelland et al. (2015) conducted a cohort in Coronary heart disease (n=6,814). Coronary artery calcium (CAC) addition to traditional risk factors vs. Traditional risk factors alone was evaluated on 10-year CHD risk prediction (C-statistic) (p=<0.0001). Adding coronary artery calcium to traditional risk factors significantly improved 10-year coronary heart disease risk prediction (C-statistic 0.80 vs 0.75, p<0.0001).