10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study)
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. The goal of this study was to derive and v...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2015-10, Vol.66 (15), p.1643-1653 |
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| creator | McClelland, Robyn L Jorgensen, Neal W Budoff, Matthew Blaha, Michael J Post, Wendy S Kronmal, Richard A Bild, Diane E Shea, Steven Liu, Kiang Watson, Karol E Folsom, Aaron R Khera, Amit Ayers, Colby Mahabadi, Amir-Abbas Lehmann, Nils Jöckel, Karl-Heinz Moebus, Susanne Carr, J Jeffrey Erbel, Raimund Burke, Gregory L |
| description | 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.
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.
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).
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.
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. |
| doi_str_mv | 10.1016/j.jacc.2015.08.035 |
| format | Article |
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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.
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).
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.
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.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2015.08.035</identifier><identifier>PMID: 26449133</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Aged, 80 and over ; Atherosclerosis - diagnostic imaging ; Atherosclerosis - ethnology ; Calcinosis - diagnostic imaging ; Calcinosis - ethnology ; Coronary Angiography - methods ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - ethnology ; Coronary Vessels - diagnostic imaging ; Ethnicity ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Tomography, X-Ray Computed ; United States - epidemiology</subject><ispartof>Journal of the American College of Cardiology, 2015-10, Vol.66 (15), p.1643-1653</ispartof><rights>Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26449133$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McClelland, Robyn L</creatorcontrib><creatorcontrib>Jorgensen, Neal W</creatorcontrib><creatorcontrib>Budoff, Matthew</creatorcontrib><creatorcontrib>Blaha, Michael J</creatorcontrib><creatorcontrib>Post, Wendy S</creatorcontrib><creatorcontrib>Kronmal, Richard A</creatorcontrib><creatorcontrib>Bild, Diane E</creatorcontrib><creatorcontrib>Shea, Steven</creatorcontrib><creatorcontrib>Liu, Kiang</creatorcontrib><creatorcontrib>Watson, Karol E</creatorcontrib><creatorcontrib>Folsom, Aaron R</creatorcontrib><creatorcontrib>Khera, Amit</creatorcontrib><creatorcontrib>Ayers, Colby</creatorcontrib><creatorcontrib>Mahabadi, Amir-Abbas</creatorcontrib><creatorcontrib>Lehmann, Nils</creatorcontrib><creatorcontrib>Jöckel, Karl-Heinz</creatorcontrib><creatorcontrib>Moebus, Susanne</creatorcontrib><creatorcontrib>Carr, J Jeffrey</creatorcontrib><creatorcontrib>Erbel, Raimund</creatorcontrib><creatorcontrib>Burke, Gregory L</creatorcontrib><title>10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study)</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>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.
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.
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).
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.
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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atherosclerosis - diagnostic imaging</subject><subject>Atherosclerosis - ethnology</subject><subject>Calcinosis - diagnostic imaging</subject><subject>Calcinosis - ethnology</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - ethnology</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>United States - epidemiology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUFv0zAUx8MEYmXwBTigd2wPCXZsJza3qu0WpG2gdgNxqlzboS5p0tkOYvv0OFsR4sbFT9b_9356Ty9J3mKUYYSL97tsJ5XKcoRZhniGCDtJRpgxnhImyufJCJWEpRiJ8jR55f0OIVRwLF4mp3lBqcCEjJ6dYJR-M9LBrHNdK909VPEXYG69kd7A0vof8NkZbVWwXQu33rbf_8JTF0wsM9ko2-9BthpunNR2YGXz1H0uVeic_wBz4-xP-aixLYStgavFagrjq74JNl2EbWsVrEKv76GrYRoB13nVDK_1E_hqwxa-yMbqfxzV9RLGlbHtA1zbX7pzNSyNkk0zObqGoQZwXq1gPI-B9MclH_PJ6-RFLRtv3hzrWXJ7vriZVenlp4uPs-llesgpDankRHPEaFFyrmsuyaYUtRY4R5pqI4pC5EJvhCoNiiEltZCY1HTDWM05NTk5S8ZP3oPr7nrjw3pvvTJxntZ0vV_jkhaRjP7_QHNMBpJF9N0R7Td7o9cHZ_fxMus_Jya_AR1xqgM</recordid><startdate>20151013</startdate><enddate>20151013</enddate><creator>McClelland, Robyn L</creator><creator>Jorgensen, Neal W</creator><creator>Budoff, Matthew</creator><creator>Blaha, Michael J</creator><creator>Post, Wendy S</creator><creator>Kronmal, Richard A</creator><creator>Bild, Diane E</creator><creator>Shea, Steven</creator><creator>Liu, Kiang</creator><creator>Watson, Karol E</creator><creator>Folsom, Aaron R</creator><creator>Khera, Amit</creator><creator>Ayers, Colby</creator><creator>Mahabadi, Amir-Abbas</creator><creator>Lehmann, Nils</creator><creator>Jöckel, Karl-Heinz</creator><creator>Moebus, Susanne</creator><creator>Carr, J Jeffrey</creator><creator>Erbel, Raimund</creator><creator>Burke, Gregory L</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>7QP</scope></search><sort><creationdate>20151013</creationdate><title>10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study)</title><author>McClelland, Robyn L ; Jorgensen, Neal W ; Budoff, Matthew ; Blaha, Michael J ; Post, Wendy S ; Kronmal, Richard A ; Bild, Diane E ; Shea, Steven ; Liu, Kiang ; Watson, Karol E ; Folsom, Aaron R ; Khera, Amit ; Ayers, Colby ; Mahabadi, Amir-Abbas ; Lehmann, Nils ; Jöckel, Karl-Heinz ; Moebus, Susanne ; Carr, J Jeffrey ; Erbel, Raimund ; Burke, Gregory L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p244t-a83d80546788df8a3b79fd9120d4de966929db9c7e08a343f9a13f4b55f884e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atherosclerosis - diagnostic imaging</topic><topic>Atherosclerosis - ethnology</topic><topic>Calcinosis - diagnostic imaging</topic><topic>Calcinosis - ethnology</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - ethnology</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McClelland, Robyn L</creatorcontrib><creatorcontrib>Jorgensen, Neal W</creatorcontrib><creatorcontrib>Budoff, Matthew</creatorcontrib><creatorcontrib>Blaha, Michael J</creatorcontrib><creatorcontrib>Post, Wendy S</creatorcontrib><creatorcontrib>Kronmal, Richard A</creatorcontrib><creatorcontrib>Bild, Diane E</creatorcontrib><creatorcontrib>Shea, Steven</creatorcontrib><creatorcontrib>Liu, Kiang</creatorcontrib><creatorcontrib>Watson, Karol E</creatorcontrib><creatorcontrib>Folsom, Aaron R</creatorcontrib><creatorcontrib>Khera, Amit</creatorcontrib><creatorcontrib>Ayers, Colby</creatorcontrib><creatorcontrib>Mahabadi, Amir-Abbas</creatorcontrib><creatorcontrib>Lehmann, Nils</creatorcontrib><creatorcontrib>Jöckel, Karl-Heinz</creatorcontrib><creatorcontrib>Moebus, Susanne</creatorcontrib><creatorcontrib>Carr, J Jeffrey</creatorcontrib><creatorcontrib>Erbel, Raimund</creatorcontrib><creatorcontrib>Burke, Gregory L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>Calcium & Calcified Tissue Abstracts</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McClelland, Robyn L</au><au>Jorgensen, Neal W</au><au>Budoff, Matthew</au><au>Blaha, Michael J</au><au>Post, Wendy S</au><au>Kronmal, Richard A</au><au>Bild, Diane E</au><au>Shea, Steven</au><au>Liu, Kiang</au><au>Watson, Karol E</au><au>Folsom, Aaron R</au><au>Khera, Amit</au><au>Ayers, Colby</au><au>Mahabadi, Amir-Abbas</au><au>Lehmann, Nils</au><au>Jöckel, Karl-Heinz</au><au>Moebus, Susanne</au><au>Carr, J Jeffrey</au><au>Erbel, Raimund</au><au>Burke, Gregory L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study)</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2015-10-13</date><risdate>2015</risdate><volume>66</volume><issue>15</issue><spage>1643</spage><epage>1653</epage><pages>1643-1653</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>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.
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.
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).
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.
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.</abstract><cop>United States</cop><pmid>26449133</pmid><doi>10.1016/j.jacc.2015.08.035</doi><tpages>11</tpages></addata></record> |
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| ispartof | Journal of the American College of Cardiology, 2015-10, Vol.66 (15), p.1643-1653 |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Atherosclerosis - diagnostic imaging Atherosclerosis - ethnology Calcinosis - diagnostic imaging Calcinosis - ethnology Coronary Angiography - methods Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - ethnology Coronary Vessels - diagnostic imaging Ethnicity Female Follow-Up Studies Humans Male Middle Aged Prospective Studies Reproducibility of Results Risk Assessment Risk Factors Tomography, X-Ray Computed United States - epidemiology |
| title | 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study) |
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