TY - JOUR
T1 - Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease
T2 - the Multi-Ethnic Study of Atherosclerosis (MESA)
AU - Blaha, Michael J.
AU - Cainzos-Achirica, Miguel
AU - Greenland, Philip
AU - McEvoy, John W.
AU - Blankstein, Ron
AU - Budoff, Matthew J.
AU - Dardari, Zeina
AU - Sibley, Christopher T.
AU - Burke, Gregory L.
AU - Kronmal, Richard A.
AU - Szklo, Moyses
AU - Blumenthal, Roger S.
AU - Nasir, Khurram
N1 - Funding Information:
We thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www. mesa-nhlbi.org.
Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Limited attention has been paid to negative cardiovascular disease (CVD) risk markers despite their potential to improve medical decision making. We compared 13 negative risk markers using diagnostic likelihood ratios (DLRs), which model the change in risk for an individual after the result of an additional test. Methods and Results-We examined 6814 participants from the Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium score of 0, carotid intima-media thickness < 25th percentile, absence of carotid plaque, brachial flow-mediated dilation > 5% change, ankle-brachial index > 0.9 and <1.3, high-sensitivity C-reactive protein < 2 mg/L, homocysteine < 10 μmol/L, N-terminal pro-brain natriuretic peptide < 100 pg/mL, no microalbuminuria, no family history of coronary heart disease (any/premature), absence of metabolic syndrome, and healthy lifestyle were compared for all and hard coronary heart disease and all CVD events over the 10-year follow-up. Models were adjusted for traditional CVD risk factors. Among all negative risk markers, coronary artery calcium score of 0 was the strongest, with an adjusted mean DLR of 0.41 (SD, 0.12) for all coronary heart disease and 0.54 (SD, 0.12) for CVD, followed by carotid intima-media thickness <25th percentile (DLR, 0.65 [SD, 0.04] and 0.75 [SD, 0.04], respectively). High-sensitivity C-reactive protein < 2 mg/L and normal ankle-brachial index had DLRs > 0.80. Among clinical features, absence of any family history of coronary heart disease was the strongest (DLRs, 0.76 [SD, 0.07] and 0.81 [SD, 0.06], respectively). Net reclassification improvement analyses yielded similar findings, with coronary artery calcium score of 0 resulting in the largest, most accurate downward risk reclassification. Conclusions-Negative results of atherosclerosis-imaging tests, particularly coronary artery calcium score of 0, resulted in the greatest downward shift in estimated CVD risk. These results may help guide discussions on the identification of individuals less likely to receive net benefit from lifelong preventive pharmacotherapy.
AB - Limited attention has been paid to negative cardiovascular disease (CVD) risk markers despite their potential to improve medical decision making. We compared 13 negative risk markers using diagnostic likelihood ratios (DLRs), which model the change in risk for an individual after the result of an additional test. Methods and Results-We examined 6814 participants from the Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium score of 0, carotid intima-media thickness < 25th percentile, absence of carotid plaque, brachial flow-mediated dilation > 5% change, ankle-brachial index > 0.9 and <1.3, high-sensitivity C-reactive protein < 2 mg/L, homocysteine < 10 μmol/L, N-terminal pro-brain natriuretic peptide < 100 pg/mL, no microalbuminuria, no family history of coronary heart disease (any/premature), absence of metabolic syndrome, and healthy lifestyle were compared for all and hard coronary heart disease and all CVD events over the 10-year follow-up. Models were adjusted for traditional CVD risk factors. Among all negative risk markers, coronary artery calcium score of 0 was the strongest, with an adjusted mean DLR of 0.41 (SD, 0.12) for all coronary heart disease and 0.54 (SD, 0.12) for CVD, followed by carotid intima-media thickness <25th percentile (DLR, 0.65 [SD, 0.04] and 0.75 [SD, 0.04], respectively). High-sensitivity C-reactive protein < 2 mg/L and normal ankle-brachial index had DLRs > 0.80. Among clinical features, absence of any family history of coronary heart disease was the strongest (DLRs, 0.76 [SD, 0.07] and 0.81 [SD, 0.06], respectively). Net reclassification improvement analyses yielded similar findings, with coronary artery calcium score of 0 resulting in the largest, most accurate downward risk reclassification. Conclusions-Negative results of atherosclerosis-imaging tests, particularly coronary artery calcium score of 0, resulted in the greatest downward shift in estimated CVD risk. These results may help guide discussions on the identification of individuals less likely to receive net benefit from lifelong preventive pharmacotherapy.
KW - Biomarkers
KW - calcium
KW - cardiac imaging techniques
KW - cardiovascular diseases
KW - risk assessment
UR - http://www.scopus.com/inward/record.url?scp=84959502403&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84959502403&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.115.018524
DO - 10.1161/CIRCULATIONAHA.115.018524
M3 - Article
C2 - 26801055
AN - SCOPUS:84959502403
SN - 0009-7322
VL - 133
SP - 849
EP - 858
JO - Circulation
JF - Circulation
IS - 9
ER -
