Key result
Astro-CHARM model with coronary artery calcium improves ASCVD risk prediction over traditional risk factors.
Why the study?
There is no available ASCVD risk prediction tool that integrates traditional risk factors and coronary artery calcium for younger individuals in the general population.
Does the Astro-CHARM model (incorporating coronary artery calcium and high-sensitivity C-reactive protein) improve ASCVD risk prediction compared to traditional risk factor models in middle-aged individuals without prior cardiovascular disease?
Cohort (n=9,439)
Yes
Does the Astro-CHARM model (incorporating coronary artery calcium and high-sensitivity C-reactive protein) improve ASCVD risk prediction compared to traditional risk factor models in middle-aged individuals without prior cardiovascular disease?
Answers are grounded in this paper and cite their sources.
The Astro-CHARM tool integrates traditional risk factors with coronary artery calcium and high-sensitivity C-reactive protein, significantly improving ASCVD risk prediction in middle-aged individuals without prior cardiovascular disease.
Background: Coronary artery calcium (CAC) is a powerful novel risk indicator for atherosclerotic cardiovascular disease (ASCVD). Currently, there is no available ASCVD risk prediction tool that integrates traditional risk factors and CAC. Methods: To develop a CAC ASCVD risk tool for younger individuals in the general population, subjects aged 40 to 65 without prior cardiovascular disease from 3 population-based cohorts were included. Cox proportional hazards models were developed incorporating age, sex, systolic blood pressure, total and high-density lipoprotein cholesterol, smoking, diabetes mellitus, hypertension treatment, family history of myocardial infarction, high-sensitivity C-reactive protein, and CAC scores (Astro-CHARM model [Astronaut Cardiovascular Health and Risk Modification]) as dependent variables and ASCVD (nonfatal/fatal myocardial infarction or stroke) as the outcome. Model performance was assessed internally, and validated externally in a fourth cohort. Results: The derivation study comprised 7382 individuals with a mean age 51 years, 45% women, and 55% nonwhite. The median CAC was 0 (25th, 75th [0,9]), and 304 ASCVD events occurred in a median 10.9 years of follow-up. The c-statistic was 0.784 for the risk factor model, and 0.817 for Astro-CHARM ( P <0.0001). In comparison with the risk factor model, the Astro-CHARM model resulted in integrated discrimination improvement (0.0252), and net reclassification improvement (0.121; P <0.0001), as well. The Astro-CHARM model demonstrated good discrimination (c=0.78) and calibration (Nam-D’Agostino χ 2 , 13.2; P =0.16) in the validation cohort (n=2057; 55 events). A mobile application and web-based tool were developed to facilitate clinical application of this tool ( www.AstroCHARM.org ). Conclusion: The Astro-CHARM tool is the first integrated ASCVD risk calculator to incorporate risk factors, including high-sensitivity C-reactive protein and family history, and CAC data. It improves risk prediction in comparison with traditional risk factor equations and could be useful in risk-based decision making for cardiovascular disease prevention in the middle-aged general population.
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Khera et al. (2018) conducted a cohort in Atherosclerotic cardiovascular disease risk (n=9,439). Astro-CHARM model vs. Traditional risk factor model was evaluated on ASCVD (nonfatal/fatal myocardial infarction or stroke) (c-statistic 0.817, p=<0.0001). The Astro-CHARM model, incorporating coronary artery calcium and risk factors, improved ASCVD risk prediction compared to traditional risk factors alone (c-statistic 0.817 vs 0.784; P<0.0001).
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