Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment

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 unte...

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Vydáno v:Journal of the American College of Cardiology Ročník 67; číslo 2; s. 139
Hlavní autoři: Yeboah, Joseph, Young, Rebekah, McClelland, Robyn L, Delaney, Joseph C, Polonsky, Tamar S, Dawood, Farah Z, Blaha, Michael J, Miedema, Michael D, Sibley, Christopher T, Carr, J Jeffrey, Burke, Gregory L, Goff, Jr, David C, Psaty, Bruce M, Greenland, Philip, Herrington, David M
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 19.01.2016
Témata:
Aged
Aged, 80 and over
Ankle Brachial Index - statistics & numerical data
Biomarkers - analysis
C-Reactive Protein - analysis
Cholesterol - analysis
Coronary Artery Disease - diagnosis
Coronary Artery Disease - drug therapy
Coronary Artery Disease - epidemiology
Coronary Vessels - metabolism
Coronary Vessels - pathology
Disease Progression
Ethnicity - statistics & numerical data
Family Health - ethnology
Family Health - statistics & numerical data
Female
Follow-Up Studies
Health Status Indicators
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Risk Assessment - methods
Risk Factors
United States - epidemiology
Vascular Calcification - epidemiology
United States
pooled cohort equation
high-sensitivity C-reactive protein
coronary artery calcium
ankle–brachial index
ISSN:1558-3597, 1558-3597
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Shrnutí: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. 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). 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. 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. 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.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2015.10.058