Coronary artery calcium score improves cardiovascular risk prediction in persons without indication for statin therapy
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Coronary artery calcium score improves cardiovascular risk prediction in persons without indication for statin therapy. / Möhlenkamp, Stefan; Lehmann, Nils; Greenland, Philip; Moebus, Susanne; Kälsch, Hagen; Schmermund, Axel; Dragano, Nico; Stang, Andreas; Siegrist, Johannes; Mann, Klaus; Jöckel, Karl-Heinz; Erbel, Raimund; Heinz Nixdorf Recall Study Investigators.
In: ATHEROSCLEROSIS, Vol. 215, No. 1, 03.2011, p. 229-36.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Coronary artery calcium score improves cardiovascular risk prediction in persons without indication for statin therapy
AU - Möhlenkamp, Stefan
AU - Lehmann, Nils
AU - Greenland, Philip
AU - Moebus, Susanne
AU - Kälsch, Hagen
AU - Schmermund, Axel
AU - Dragano, Nico
AU - Stang, Andreas
AU - Siegrist, Johannes
AU - Mann, Klaus
AU - Jöckel, Karl-Heinz
AU - Erbel, Raimund
AU - Heinz Nixdorf Recall Study Investigators
AU - Meinertz, Thomas
N1 - Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PY - 2011/3
Y1 - 2011/3
N2 - BACKGROUND: Recent revision to the Canadian Cardiovascular Society (CCS) guidelines on cardiovascular disease (CVD) risk stratification provides expanded recommendations for statin therapy. If CVD risk in the remaining individuals can further be stratified and discriminated by additional risk assessment using coronary artery calcium (CAC) scoring is unknown.METHODS AND RESULTS: In a retrospectively analyzed subgroup comprising 1934 participants from the Heinz Nixdorf Recall study, who did not meet criteria for statin therapy based on current CCS guidelines, traditional CVD risk variables and CAC were measured. Between 2000 and 2008, incident CVD events, i.e. coronary deaths, non-fatal myocardial infarction, coronary revascularization, stroke and CV death were determined. Those 43 participants who experienced 55 CVD events (5-year risk to first event: 2.2% (1.6-3.0%)) had higher CAC scores than those who did not (p<0.0001). In multiple Cox regression analysis including age, sex, total-/HDL-cholesterol ratio, and antihypertensive medication, log2(CAC+1) remained an independent predictor of CVD events (HR=1.21 (1.09-1.33), p<0.001). Measures of discrimination improved with the addition of CAC into the model: the incremental discrimination improvement was 0.0167, p=0.014. Net reclassification improvement using risk categories of 0-<3%, 3-10% and >10% was 25.1%, p=0.01, largely driven by a 32.6% correct up-classification in persons with events. Yet, only 38 (2%) of participants were identified being at high risk using CAC imaging in addition to traditional risk factor assessment.CONCLUSION: Adding CAC to traditional risk assessment in persons without indication for statin therapy improves discrimination. However, reclassification to the high risk category and overall event rates seem too low to justify liberal CAC testing in all these individuals.
AB - BACKGROUND: Recent revision to the Canadian Cardiovascular Society (CCS) guidelines on cardiovascular disease (CVD) risk stratification provides expanded recommendations for statin therapy. If CVD risk in the remaining individuals can further be stratified and discriminated by additional risk assessment using coronary artery calcium (CAC) scoring is unknown.METHODS AND RESULTS: In a retrospectively analyzed subgroup comprising 1934 participants from the Heinz Nixdorf Recall study, who did not meet criteria for statin therapy based on current CCS guidelines, traditional CVD risk variables and CAC were measured. Between 2000 and 2008, incident CVD events, i.e. coronary deaths, non-fatal myocardial infarction, coronary revascularization, stroke and CV death were determined. Those 43 participants who experienced 55 CVD events (5-year risk to first event: 2.2% (1.6-3.0%)) had higher CAC scores than those who did not (p<0.0001). In multiple Cox regression analysis including age, sex, total-/HDL-cholesterol ratio, and antihypertensive medication, log2(CAC+1) remained an independent predictor of CVD events (HR=1.21 (1.09-1.33), p<0.001). Measures of discrimination improved with the addition of CAC into the model: the incremental discrimination improvement was 0.0167, p=0.014. Net reclassification improvement using risk categories of 0-<3%, 3-10% and >10% was 25.1%, p=0.01, largely driven by a 32.6% correct up-classification in persons with events. Yet, only 38 (2%) of participants were identified being at high risk using CAC imaging in addition to traditional risk factor assessment.CONCLUSION: Adding CAC to traditional risk assessment in persons without indication for statin therapy improves discrimination. However, reclassification to the high risk category and overall event rates seem too low to justify liberal CAC testing in all these individuals.
KW - Aged
KW - Calcinosis/complications
KW - Calcium/analysis
KW - Cardiovascular Diseases/etiology
KW - Cohort Studies
KW - Coronary Artery Disease/complications
KW - Coronary Vessels/chemistry
KW - Female
KW - Humans
KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
KW - Male
KW - Middle Aged
KW - Radiography
KW - Retrospective Studies
KW - Risk
KW - Risk Assessment/methods
KW - Tomography
U2 - 10.1016/j.atherosclerosis.2010.12.014
DO - 10.1016/j.atherosclerosis.2010.12.014
M3 - SCORING: Journal article
C2 - 21251655
VL - 215
SP - 229
EP - 236
JO - ATHEROSCLEROSIS
JF - ATHEROSCLEROSIS
SN - 0021-9150
IS - 1
ER -
