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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Vydané v:	Journal of the American College of Cardiology Ročník 67; číslo 2; s. 139
Hlavní autori:	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:	English
Vydavateľské údaje:	United States 19.01.2016
Predmet:	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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Abstract	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.
AbstractList	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.BACKGROUNDThe 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).OBJECTIVESThis 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.METHODSThe 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.RESULTSOf 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.CONCLUSIONSCAC 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. 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.
Author	Burke, Gregory L Psaty, Bruce M McClelland, Robyn L Polonsky, Tamar S Miedema, Michael D Delaney, Joseph C Goff, Jr, David C Carr, J Jeffrey Dawood, Farah Z Herrington, David M Yeboah, Joseph Young, Rebekah Sibley, Christopher T Greenland, Philip Blaha, Michael J
Author_xml	– sequence: 1 givenname: Joseph surname: Yeboah fullname: Yeboah, Joseph email: jyeboah@wakehealth.edu organization: Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, North Carolina. Electronic address: jyeboah@wakehealth.edu – sequence: 2 givenname: Rebekah surname: Young fullname: Young, Rebekah organization: Department of Biostatistics, University of Washington, Seattle, Washington – sequence: 3 givenname: Robyn L surname: McClelland fullname: McClelland, Robyn L organization: Department of Biostatistics, University of Washington, Seattle, Washington – sequence: 4 givenname: Joseph C surname: Delaney fullname: Delaney, Joseph C organization: Department of Biostatistics, University of Washington, Seattle, Washington – sequence: 5 givenname: Tamar S surname: Polonsky fullname: Polonsky, Tamar S organization: Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois – sequence: 6 givenname: Farah Z surname: Dawood fullname: Dawood, Farah Z organization: Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, North Carolina – sequence: 7 givenname: Michael J surname: Blaha fullname: Blaha, Michael J organization: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland – sequence: 8 givenname: Michael D surname: Miedema fullname: Miedema, Michael D organization: Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota – sequence: 9 givenname: Christopher T surname: Sibley fullname: Sibley, Christopher T organization: Radiology, Oregon Health and Science University, Portland, Oregon – sequence: 10 givenname: J Jeffrey surname: Carr fullname: Carr, J Jeffrey organization: Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee – sequence: 11 givenname: Gregory L surname: Burke fullname: Burke, Gregory L organization: Public Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina – sequence: 12 givenname: David C surname: Goff, Jr fullname: Goff, Jr, David C organization: Public Health, University of Colorado School of Public Health, Aurora, Colorado – sequence: 13 givenname: Bruce M surname: Psaty fullname: Psaty, Bruce M organization: Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington – sequence: 14 givenname: Philip surname: Greenland fullname: Greenland, Philip organization: Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 15 givenname: David M surname: Herrington fullname: Herrington, David M organization: Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, North Carolina
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26791059$$D View this record in MEDLINE/PubMed
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Keywords	pooled cohort equation high-sensitivity C-reactive protein coronary artery calcium ankle–brachial index
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References	27230056 - J Am Coll Cardiol. 2016 May 31;67(21):2558-9. doi: 10.1016/j.jacc.2016.02.077. 26791060 - J Am Coll Cardiol. 2016 Jan 19;67(2):148-150. doi: 10.1016/j.jacc.2015.11.009.
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Snippet	The improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart...
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SubjectTerms	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
Title	Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment
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