Key result
Adding computed tomography risk markers to the Framingham risk score and coronary artery calcium worsened discrimination for incident CHD (AUC 0.712 vs 0.569-0.655; p<0.01).
Why the study?
Does the addition of CT-derived risk markers (TAC, AVC, MAC, PAT, LA) to the Framingham risk score and CAC improve the prediction of incident CHD and CVD in nondiabetic individuals?
Cohort (n=5,745)
Does the addition of CT-derived risk markers (TAC, AVC, MAC, PAT, LA) to the Framingham risk score and CAC improve the prediction of incident CHD and CVD in nondiabetic individuals?
Effect estimate: AUC 0.569-0.655
p-value: p=< 0.01
Adding other CT-derived cardiovascular risk markers to the Framingham risk score and coronary artery calcium worsens risk discrimination for incident CHD and CVD, suggesting CAC remains the superior imaging marker for risk prediction.
CT markers associated with worsened discrimination beyond CAC; challenges incremental utility and should not yet alter clinical risk models.
AIM: We assess the improvement in discrimination afforded by the addition of the computed tomography risk markers thoracic aorta calcium (TAC), aortic valve calcification (AVC), mitral annular calcification (MAC), pericardial adipose tissue volume (PAT), and liver attenuation (LA) to the Framingham risk score (FRS) + coronary artery calcium (CAC) for incident coronary heart disease (CHD) and incident cerebrovascular disease (CVD) in a multiethnic cohort. METHODS AND RESULTS: A total of 5745 participants were enrolled, with 2710 at intermediate Framingham risk, 210 CVD events, and 155 CHD events). Over 9 years of follow up, 251 had adjudicated CHD, 346 had CVD events, and 321 died. The data were analysed using Cox proportional hazard, receiver operator curve (ROC), and net reclassification improvement (NRI) analyses. In the whole cohort and also when the analysis was restricted to only the intermediate-risk participants, CAC, TAC, AVC, and MAC were all significantly associated with incident CVD, incident CHD, and mortality, and CAC had the strongest association. When added to the FRS, CAC had the highest area under the curve (AUC) for the prediction of incident CVD and incident CHD; LA had the least. The addition of TAC, AVC, MAC, PAT, and LA to FRS + CAC all resulted in a significant reduction in AUC for incident CHD (0.712 vs. 0.646, 0.655, 0.652, 0.648, and 0.569; all p < 0.01, respectively) in participants with intermediate FRS. The addition of CAC to FRS resulted in an NRI of 0.547 for incident CHD in the intermediate-risk group. The NRI when TAC, AVC, MAC, PAT, and LA were added to FRS + CAC were 0.024, 0.026, 0.019, 0.012, and 0.012, respectively, for incident CHD in the intermediate-risk group. Similar results were obtained for incident CVD in the intermediate-risk group and also when the whole cohort was used instead of the intermediate FRS group. CONCLUSIONS: The addition of CAC to the FRS provides superior discrimination especially in intermediate-risk individuals compared with the addition of TAC, AVC, MAC, PAT, or LA for incident CVD and incident CHD. Compared with FRS + CAC, the addition of TAC, AVC, MAC, PAT, or LA individually to FRS + CAC worsens the discrimination for incident CVD and incident CHD. These risk markers are unlikely to be useful for improving cardiovascular risk prediction.
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Yeboah et al. (2013) conducted a cohort in nondiabetics (n=5,745). Addition of computed tomography risk markers (TAC, AVC, MAC, PAT, LA) to FRS + CAC vs. Framingham risk score (FRS) + coronary artery calcium (CAC) was evaluated on incident coronary heart disease (CHD) (AUC 0.569-0.655, p=< 0.01). Adding computed tomography risk markers to the Framingham risk score and coronary artery calcium worsened discrimination for incident CHD (AUC 0.712 vs 0.569-0.655; p<0.01).
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