10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors

Abstract

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 Our goal 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 Multi-Ethnic Study of Atherosclerosis (MESA), a prospective community-based cohort study of 6814 participants aged 45–84, free of clinical heart disease at baseline and followed for 10 years. MESA is gender balanced and included 39% Non-Hispanic whites, 12% Chinese American, 28% African American, and 22% Hispanic Americans. External validation was conducted in the Heinz Nixdorf Recall Study (HNR) and the Dallas Heart Study (DHS). Results Inclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 versus 0.75, p<0.0001). External validation in both HNR and DHS 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 non-events was approximately 8–9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within half 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 in the communication of risk to patients and when determining risk-based treatment strategies.

The role of nurse practitioners in primary care in optimizing risk stratification for coronary heart disease in Canadian women: an integrative review

“…Findings were confirmed in a similar but more recent study conducted by McClelland et al (2015). In this key study, McClelland et al (2015) derived and validated a novel risk score known as the Multi-Ethnic Study of Atherosclerosis (MESA) risk score.…”

“…Of these, CAC screening has the most compelling emerging data in women (Kelkar et al, 2016;McClelland et al, 2015;& Polonsky et al, 2010). The CAC score is calculated during a standard cardiac computed tomography scan and measures of the amount of calcium in the walls of the epicardial coronary arteries that supply the heart (Golf, 2014).…”

“…In this key study, McClelland et al (2015) derived and validated a novel risk score known as the Multi-Ethnic Study of Atherosclerosis (MESA) risk score. The MESA risk score incorporated CAC screening with traditional risk factors to estimate the 10-year risk of developing CHD (McClelland et al, 2015).…”

“…In this key study, McClelland et al (2015) derived and validated a novel risk score known as the Multi-Ethnic Study of Atherosclerosis (MESA) risk score. The MESA risk score incorporated CAC screening with traditional risk factors to estimate the 10-year risk of developing CHD (McClelland et al, 2015). The algorithm was validated in the MESA cohort, a prospective community-based population of 6,814 sex-balanced multiethnic (39% non-Hispanic Caucasians, 12% Chinese Americans, 28% African Americans and 22% Hispanic Americans) participants.…”

Use and Customization of Risk Scores for Predicting Cardiovascular Events Using Electronic Health Record Data

“…11,12 Most efforts to validate cardiovascular risk prediction models use data from longitudinal cohort studies. [13][14][15][16][17][18][19][20] However, in practice, these risk scores are typically used to counsel the set of patients seen routinely in a clinic setting, a population that may be quite different from those enrolled in longitudinal cohort studies. Further, in clinical settings the risk factor values used to predict risk will often be obtained from the electronic health record, in contrast to longitudinal cohort studies, where risk factors are measured using wellestablished protocols.…”