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Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.

ABSTRACT: BACKGROUND:The improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines to the atherosclerotic cardiovascular disease (ASCVD) risk estimator (pooled cohort equation [PCE]) is untested. OBJECTIVES:This study assessed the predictive accuracy and improvement in reclassification gained by the addition of the coronary artery calcium (CAC) score, the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) levels, and family history (FH) of ASCVD to the PCE in participants of MESA (Multi-Ethnic Study of Atherosclerosis). METHODS:The PCE was calibrated (cPCE) and used for this analysis. The Cox proportional hazards survival model, Harrell's C statistics, and net reclassification improvement analyses were used. ASCVD was defined as myocardial infarction, coronary heart disease-related death, or fatal or nonfatal stroke. RESULTS:Of 6,814 MESA participants not prescribed statins at baseline, 5,185 had complete data and were included in this analysis. Their mean age was 61 years; 53.1% were women, 9.8% had diabetes, and 13.6% were current smokers. After 10 years of follow-up, 320 (6.2%) ASCVD events occurred. CAC score, ABI, and FH were independent predictors of ASCVD events in the multivariable Cox models. CAC score modestly improved the Harrell's C statistic (0.74 vs. 0.76; p = 0.04); ABI, hsCRP levels, and FH produced no improvement in Harrell's C statistic when added to the cPCE. CONCLUSIONS:CAC score, ABI, and FH were independent predictors of ASCVD events. CAC score modestly improved the discriminative ability of the cPCE compared with other nontraditional risk markers.

SUBMITTER: Yeboah J

PROVIDER: S-EPMC4724058 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.

Yeboah Joseph J Young Rebekah R McClelland Robyn L RL Delaney Joseph C JC Polonsky Tamar S TS Dawood Farah Z FZ Blaha Michael J MJ Miedema Michael D MD Sibley Christopher T CT Carr J Jeffrey JJ Burke Gregory L GL Goff David C DC Psaty Bruce M BM Greenland Philip P Herrington David M DM

Journal of the American College of Cardiology 20160101 2

<h4>Background</h4>The improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines to the atherosclerotic cardiovascular disease (ASCVD) risk estimator (pooled cohort equation [PCE]) is untested.<h4>Objectives</h4>This study assessed the predictive accuracy and improvement in reclassification gained by the addition of the coronary artery calcium (CAC) score, the ankle- ...[more]

PMID: 26791059

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Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.

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Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.

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