Author + information
- Suzette E. Elias-Smale, MD⁎ ( and )
- Jacqueline C.M. Witteman, PhD
- ↵⁎Department of Epidemiology, Erasmus Medical Center, P.O. Box 2040, Rotterdam, Zuid-Holland 3000 DR, the Netherlands
We agree with the comments of Dr. McEvoy and colleagues regarding our paper (1) that there is an urge to implement coronary artery calcium (CAC) cutoff scores in clinical practice to enhance cardiovascular risk stratification in the individual patient. This especially pertains to persons at intermediate cardiovascular risk, in whom risk management strategies are least clear. Yet, we do not think that reporting the absolute CAC score reclassification cutoffs we would have found by using the classic Framingham Risk Score instead of our Framingham “refitted” model would be helpful. The Framingham Risk Score is designed for a population 30 to 74 years of age (2). Our study focuses on the elderly, of whom a substantial proportion is older than 75 years of age. Previous research within the Rotterdam study has pointed out that the Framingham Risk Score does not fit well in our population (3). Thus, cutoffs derived in our cohort using the Framingham Risk Score would not be meaningful.
Of course, in a utopia we would be able to overcome the inaccuracy of available “general” risk functions. However, we think it would be helpful to create more tailored risk functions for populations with specific demographics and/ or presence of cardiovascular symptoms. Empirically derived cutoffs from these populations are more likely to apply to the individual patient, although they should be tested in comparable study populations before they can be safely used in clinical practice. So, despite the urgent need for CAC cutoffs in cardiovascular risk stratification of the individual patient, we feel that abundant research still has to be performed before CAC cutoff scores can safely be used in clinical practice.
- American College of Cardiology Foundation
- Elias-Smale S.E.,
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