Author + information
- Received July 12, 2015
- Revision received September 8, 2015
- Accepted October 27, 2015
- Published online January 19, 2016.
- Joseph Yeboah, MD, MS∗∗ (, )
- Rebekah Young, PhD†,
- Robyn L. McClelland, PhD†,
- Joseph C. Delaney, PhD†,
- Tamar S. Polonsky, MD, MSci‡,
- Farah Z. Dawood, MD, MS∗,
- Michael J. Blaha, MD, MPH§,
- Michael D. Miedema, MD, MPH‖,
- Christopher T. Sibley, MD¶,
- J. Jeffrey Carr, MD, MSc#,
- Gregory L. Burke, MD, MS∗∗,
- David C. Goff Jr., MD, PhD††,
- Bruce M. Psaty, MD, PhD‡‡,
- Philip Greenland, MD§§ and
- David M. Herrington, MD, MHS∗
- ∗Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, North Carolina
- †Department of Biostatistics, University of Washington, Seattle, Washington
- ‡Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois
- §Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- ‖Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
- ¶Radiology, Oregon Health and Science University, Portland, Oregon
- #Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- ∗∗Public Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- ††Public Health, University of Colorado School of Public Health, Aurora, Colorado
- ‡‡Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington
- §§Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- ↵∗Reprint requests and correspondence:
Dr. Joseph Yeboah, Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157.
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.
- ankle–brachial index
- coronary artery calcium
- high-sensitivity C-reactive protein
- pooled cohort equation
This research 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 and UL1-RR-025005 from the National Center for Research Resources. Dr. Psaty served on the Drug Safety Monitoring Board for a clinical trial funded by the device manufacturer (Zoll LifeCor) and served on the Drug Safety Monitoring Board of the Yale Open Data Access Project funded by Johnson & Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 12, 2015.
- Revision received September 8, 2015.
- Accepted October 27, 2015.
- 2016 American College of Cardiology Foundation