Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women: A Meta-analysis
Authors' conclusion
Among women at low ASCVD risk, CAC was present in approximately one-third and was associated with an increased risk of ASCVD and modest improvement in prognostic accuracy compared with traditional risk factors.
Study context
- Population
- Women with 10-year atherosclerotic CVD (ASCVD) risk <7.5% from 5 population-based cohorts (Dallas Heart, Framingham Heart, Heinz Nixdorf Recall, MESA, Rotterdam); Coronary artery calcium (CAC) scans 1998–2006
- Participants
- 6,739 women5 cohorts
- Comparison
- CAC >0 vs CAC = 0
- Outcome
- Incident ASCVD (nonfatal MI, CHD death, stroke)
- Follow-up
- Median 7.0 to 11.6 years across cohorts
Methodological detailsfixed-effects meta-analysis, multicentre, US, Germany, Netherlands cohorts
- Fixed-effects meta-analysis
- Multicentre
- US, Germany, Netherlands cohorts
Pooled result
As reported in the abstract
Incident ASCVD
CAC presence vs CAC absenceDifference, per 1000 person-years (95% CI)
Incident ASCVD
2.92(2.02–3.83)
CAC presence vs CAC absenceHazard ratio (95% CI)
Multivariable-adjusted
2.04(1.44–2.90)
Further pooled results
Prevalence of CAC
- CAC present
- 36.1%
ASCVD events overall
- Total ASCVD events
- 165
- Nonfatal MI
- 64
- Coronary heart disease (CHD) deaths
- 29
- Strokes
- 72
- ASCVD incidence rates across cohorts (per 1000 person-years)
- 1.5 to 6.0
ASCVD prediction: addition of CAC to traditional risk factors
- C statistic, traditional risk factors
- 0.73 (95% CI 0.69-0.77)
- C statistic, with CAC
- 0.77 (95% CI 0.74-0.81)
- Continuous net reclassification improvement (cNRI)
- 0.20 (95% CI 0.09-0.31)
Original publication
Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women: A Meta-analysis. JAMA. Published 22 November 2016. doi:10.
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