Comparison of Novel Risk Markers for Improvement in Cardiovascular Risk Assessment in Intermediate Risk Individuals. The Multi-Ethnic Study of Atherosclerosis

By J. Yeboah, R. McClelland, Tamar S. Polonsky, G. Burke, C. Sibley, D. O'leary, J. Carr, D. Goff, P. Greenland, D. Herrington. Journal of the American Medical Association (JAMA), 2012

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Context Risk markers including coronary artery calcium (CAC), carotid intima-media thickness (CIMT), ankle-brachial Index (ABI), brachial flow-mediated dilation (FMD), high sensitivity C -reactive protein (hs-CRP) and family history (FH) of coronary heart disease (CHD) have been reported to improve on the Framingham risk score (FRS) for prediction of CHD. However, there are no direct comparisons of these markers for risk prediction in a single cohort. Objective We compared improvement in prediction of incident CHD/cardiovascular disease (CVD) of these 6 risk markers within intermediate risk participants (5 % < FRS < 20%) in the Multi-Ethnic Study of Atherosclerosis (MESA). Design, Setting and Participants Of 6814 MESA participants from 6 US field centers, 1330 were intermediate risk, without diabetes mellitus, and had complete data on all 6 markers. Recruitment spanned July 2000 to September 2002; follow-up extended through May 2011. Probability- weighted Cox proportional hazard models were used to estimate hazard ratios (HR). Area under the receiver operator characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare incremental contributions of each marker when added to the FRS + race/ethnicity. Main Outcome Measures Incident CHD defined as MI, angina followed by revascularization, resuscitated cardiac arrest or CHD death. Incident CVD additionally included stroke or CVD death. Results After median follow-up of 7.6 years (IQR 7.3 – 7.8 years), 94 CHD and 123 CVD events occurred. CAC, ABI, hs-CRP and FH were independently associated with incident CHD in multivariable analyses [HR (95%CI: 2.60(1.94-3.50), 0.79(0.66-0.95), 1.28(1.00-1.64) and 2.18(1.38-3.42) respectively]. CIMT and FMD were not associated with incident CHD in multivariable analyses [HR (95%CI) 1.17(0.95- 1.45) and 0.95(0.78 −1.14) respectively]. Although the addition of the markers individually to the FRS +race/ethnicity improved the AUC, CAC afforded the highest increment (0.623 vs. 0.784) while FMD afforded the least [0.623 vs. 0.639]. For incident CHD, the NRI with CAC was 0.659, FMD 0.024, ABI 0.036, CIMT 0.102, FH 0.160 and hs-CRP 0.079. Similar results were obtained for incident CVD. Conclusion CAC, ABI, hs-CRP and FH are independent predictors of incident CHD/CVD in intermediate risk individuals. CAC provides superior discrimination and risk reclassification compared with other risk markers.

Subfields: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging, Surgery

View Paper: https://www.semanticscholar.org/paper/f49292fe84cf635683d9c29fb8efe811a1496900

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Citations in the corpus

Generative Adversarial Networks for Noise Reduction in Low-Dose CT (2017, neutral): “events [19].”
National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. (2015, background): “aspx).(281) In some patients, the 75th percentile may yield a CAC threshold well below 300 Agatston units.”
Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events (2014, neutral): “17 For this report, we analyzed 2 separate end points: (1) hard CHD, defined as myocardial infarction, resuscitated cardiac arrest, or CHD death; and (2) hard CVD, defined as hard CHD, stroke, or stroke death.”
2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. (2016, background): “49 A CAC measurement > 100 is associated with a high risk ( > 2% annual risk) of a CVD event within 2-5 years and is generally an indication for intensive treatment of LDL-C as well as other treatable CV risk factors.”
The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. (2015, background): “9% for coronary heart disease was reported [64] (Table 3).”