Author + information
- Received April 28, 2015
- Revision received August 9, 2015
- Accepted August 10, 2015
- Published online October 13, 2015.
- Robyn L. McClelland, PhD∗∗ (, )
- Neal W. Jorgensen, MS∗,
- Matthew Budoff, MD†,
- Michael J. Blaha, MD, MPH‡,
- Wendy S. Post, MD, MS‡,
- Richard A. Kronmal, PhD∗,
- Diane E. Bild, MD, MPH§,
- Steven Shea, MD, MS‖,
- Kiang Liu, PhD¶,
- Karol E. Watson, MD, PhD#,
- Aaron R. Folsom, MD∗∗,
- Amit Khera, MD††,
- Colby Ayers, MS‡‡,
- Amir-Abbas Mahabadi, MD§§,
- Nils Lehmann, PhD‖‖,
- Karl-Heinz Jöckel, PhD‖‖,
- Susanne Moebus, PhD‖‖,
- J. Jeffrey Carr, MD, MS¶¶,
- Raimund Erbel, MD, PhD§§ and
- Gregory L. Burke, MD, MS##
- ∗Department of Biostatistics, University of Washington, Seattle, Washington
- †Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Los Angeles, California
- ‡Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
- §Patient-Centered Outcomes Research Institute, Washington, DC
- ‖Departments of Medicine and Epidemiology, Columbia University, New York, New York
- ¶Department of Preventive Medicine, Northwestern University Medical School, Chicago, Illinois
- #Division of Cardiology, UCLA School of Medicine, Los Angeles, California
- ∗∗Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
- ††Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas
- ‡‡Division of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
- §§University Clinic Essen, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Essen, Germany
- ‖‖Institute of Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, University of Duisburg, Essen, Germany
- ¶¶Department of Radiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- ##Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- ↵∗Reprint requests and correspondence:
Dr. Robyn L. McClelland, Department of Biostatistics, University of Washington, Building 29, Suite 310, 6200 Northeast 74th Street, Seattle, Washington 98115.
Background Several studies have demonstrated the tremendous potential of using coronary artery calcium (CAC) in addition to traditional risk factors for coronary heart disease (CHD) risk prediction. However, to date, no risk score incorporating CAC has been developed.
Objectives The goal of this study was to derive and validate a novel risk score to estimate 10-year CHD risk using CAC and traditional risk factors.
Methods Algorithm development was conducted in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective community-based cohort study of 6,814 participants age 45 to 84 years, who were free of clinical heart disease at baseline and followed for 10 years. MESA is sex balanced and included 39% non-Hispanic whites, 12% Chinese Americans, 28% African Americans, and 22% Hispanic Americans. External validation was conducted in the HNR (Heinz Nixdorf Recall Study) and the DHS (Dallas Heart Study).
Results Inclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 vs. 0.75; p < 0.0001). External validation in both the HNR and DHS studies provided evidence of very good discrimination and calibration. Harrell’s C-statistic was 0.779 in HNR and 0.816 in DHS. Additionally, the difference in estimated 10-year risk between events and nonevents was approximately 8% to 9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within one-half of a percent of the observed event rate.
Conclusions An accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. The MESA risk score, which is available online on the MESA web site for easy use, can be used to aid clinicians when communicating risk to patients and when determining risk-based treatment strategies.
Analysis and methods development for this project was supported by R01 HL 103729-01A1 from the National Heart, Lung, and Blood Institute. MESA was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1 TR 001079, and UL1-RR-025005 from National Center for Research Resources. The HNR study is funded by a contract with the private Heinz Nixdorf Foundation and undergoes continuous monitoring by government agencies led by the Bundesministerium für Bildung und Forschung; and is also supported by the German Ministry of Education and Science. DHS was funded by the Donald W. Reynolds Foundation; and partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1TR001105. Survey instrument development was funded in part by a Patient Care and Outcomes Research Grant from the American Heart Association. Dr. Budoff has received grant support from GE. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 28, 2015.
- Revision received August 9, 2015.
- Accepted August 10, 2015.
- American College of Cardiology Foundation