What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Primary cardiovascular prevention (n=5144). Intervention: Coronary risk calculators (SCORE, SCORE-HDL, PROCAM, AGLA, FRAM, PCE) vs. Carotid ultrasound (Total Plaque Area ≥ 80 mm2). Primary outcome: Sensitivity and discriminatory performance (AUC) to detect total plaque area ≥ 80 mm2 (TPA80).

March 14, 2017Open Access

Extensive carotid atherosclerosis and the diagnostic accuracy of coronary risk calculators

Key Result

Current high-risk thresholds of American and European coronary risk calculators demonstrated low sensitivity (ranging from 5% to 39%) for detecting subclinical carotid atherosclerosis (TPA ≥ 80 mm2).

Study Design

Type

Cross-Sectional (n=5,144)

Multicenter

Yes

Structured PICO

Do current coronary risk calculators accurately detect extensive subclinical carotid atherosclerosis (TPA80) in younger individuals?

Population

5,144 individuals in age groups 40–55, 56–65, and 66–75 from Germany (N = 2942) and Switzerland (N = 2202)

Intervention

Coronary risk calculators (SCORE, SCORE-HDL, PROCAM, AGLA, FRAM and PCE)

Outcome

Sensitivity, specificity, and discriminatory performance (AUC) to detect subclinical carotid atherosclerosis defined as total plaque area > 80 mm2 (TPA80)surrogate

Current American and European coronary risk calculators have low sensitivity for detecting extensive subclinical carotid atherosclerosis in younger individuals, suggesting potential underestimation of risk.

Limitations

Study examines practice-based groups of subjects, which cannot be extrapolated to the entire population
Images were obtained within a clinical setting as part of routine measurements by two different observers
No hard coronary outcome data presented in this study

Abstract

Preventive therapy in primary care is guided by risk thresholds for future cardiovascular events. We aimed to assess whether the sensitivity of various risk calculators for the detection of subclinical carotid atherosclerosis (TPA80) could be improved by lowering risk thresholds in younger age groups. We compared sensitivity, specificity, and discriminatory performance of SCORE, SCORE-HDL, PROCAM, AGLA, FRAM and PCE coronary risk calculators to detect total plaque area > 80 mm2 (TPA80), a coronary risk equivalent, in age groups 40–55, 56–65, 66–75 from Germany (DE, N = 2942) and Switzerland (CH, N = 2202) during the years 2002 to 2016. All calculators showed good to moderate discriminatory performance to detect TPA80 with AUC ranging from 0.74 (CH-AGLA) to 0.87 (DE- SCORE), but the sensitivity of high risk risk thresholds varied widely from 39% for DE-FRAM-CVD to 5% for CH-AGLA. Lowering of the risk threshold increased sensitivity substantially at the expense of minor losses in specificity, but the sensitivity generally remained < 45% at the 90% specificity threshold. Current risk thresholds of American and European coronary risk calculators have a low sensitivity to detect TPA80 in younger individuals.

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