Prevention & lipidsCohort study
Predictive Utility of Coronary Artery Calcium Score Added to the PREVENT Atherosclerotic Cardiovascular Disease Equations
- Longitudinal observational cohort study
- 6 sites in the United States
- Multi-Ethnic Study of Atherosclerosis
Authors' conclusion
Among US adults aged 45 to 79 years, addition of CAC score to the PREVENT-ASCVD equations across all risk groups overall only modestly improved and, in some groups, did not change model discrimination and reclassification. Reclassification results support selective use of CAC in those with borderline to intermediate risk estimated by the PREVENT-ASCVD equations.
Study context
- Population
- Adult participants aged 45 to 79 years without atherosclerotic cardiovascular disease (ASCVD) at baseline in the Multi-Ethnic Study of Atherosclerosisparticipants included, 366 (6%) experienced an ASCVD event during 10 years of follow-up
- Participants
- 6,098 participants
- Exposure
- Ten-year ASCVD risk with the PREVENT-ASCVD equations before and after adding coronary artery calcium (CAC) scores
- Outcome
- Performance metrics for estimation of risk of fatal and nonfatal ASCVD (Harrell C statistic, calibration, NRI for risk categories low <3%, borderline 3% to <5%, intermediate 5% to <10%, high ≥10%)
- Follow-up
- 10 years
Main finding
As reported in the abstract
PREVENT-ASCVD base equations
0.73 (95% CI, 0.70-0.75)
Harrell C statistic · Calibration slope 1.09 (95% CI, 0.93-1.25)
PREVENT-ASCVD base plus CAC equations
0.92 (95% CI, 0.81-1.03)
Calibration slope
- PREVENT-ASCVD base plus CAC equations vs PREVENT-ASCVD base equations
- change in Harrell C statistic 0.02 (95% CI 0.01–0.03)
- PREVENT-ASCVD base plus CAC equations vs PREVENT-ASCVD base equations
- categorical net reclassification improvement (NRI) 0.095 (95% CI 0.053–0.137)
Observational data: associations, not effects.
Further findings
Baseline characteristics
- Mean age
- 61.4 (SD, 9.6) years
- Female
- 52%
- Mean estimated 10-year ASCVD risk with the PREVENT-ASCVD base equations
- 6.4% (SD, 4.8%)
- CAC score greater than 0
- 49%
Incident ASCVD by CAC score among those at borderline risk (subgroup)
- CAC score of 0 (among those at borderline risk)
- 1.9%
- CAC greater than 0 and less than 100 (among those at borderline risk)
- 3.9%
- CAC 100 or greater and less than 300 (among those at borderline risk)
- 7.4%
- CAC 300 or greater (among those at borderline risk)
- 14.3%
Original publication
Summarised from the published abstract; every number is checked against it