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
N1 - Funding Information:
We thank the Heinz Nixdorf Foundation , Germany, for their generous support of this study. This study is also supported by the German Ministry of Education and Science (BMBF) , and the German Aerospace Center (Deutsches Zentrum für Luft- und Raumfahrt, DLR), Bonn, Germany. We thank Prof. K. Lauterbach (Dept. of Health Economy and Epidemiology, University of Cologne, Germany) for his valuable contributions in an early phase of the study. Assessment of psychosocial factors and neighborhood level information is funded by the German Research Council (DFG; Project SI 236/8–1 and SI 236/9-1). We acknowledge the support of the Sarstedt AG & Co. (Nümbrecht, Germany) concerning laboratory equipment. We are indebted to all study participants and both to the dedicated personnel of the study center of the Heinz Nixdorf Recall study and the EBT-scanner facilities and to the investigative group, in particular to U. Roggenbuck, S. Slomiany, E.M. Beck, A. Öffner, S. Münkel, M. Bauer, S. Schrader, R. Peter, and H. Hirche.
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 - Cardiac CT
KW - Coronary artery calcium
KW - Prevention
KW - Risk prediction
KW - Statins
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U2 - 10.1016/j.atherosclerosis.2010.12.014
DO - 10.1016/j.atherosclerosis.2010.12.014
M3 - Article
C2 - 21251655
AN - SCOPUS:79952108128
VL - 215
SP - 229
EP - 236
JO - Atherosclerosis
JF - Atherosclerosis
SN - 0021-9150
IS - 1
ER -
