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CAC an alternative marker to age for CHD risk prediction
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As an alternative to age, coronary artery calcium may be a better marker to discriminate between lower and higher CHD risk in older adults, according to new data published in JAMA Cardiology.
However, Yuichiro Yano, MD, PhD, from the department of preventative medicine at Northwestern University Feinberg School of Medicine in Chicago, and colleagues noted that, “given the absence of clear agreement on risk thresholds to initiate statins for primary prevention of atherosclerotic CVD in older adults, clinical judgement and patient input are critical components during the decision-making process. CAC score may assist in such a shared decision-making approach.”
The researchers analyzed pooled U.S. population-based studies (Framingham Heart Study, Multi-Ethnic Study of Atherosclerosis [MESA] and Cardiovascular Health Study) to evaluate the predictive ability of CAC score, compared with age, for incident atherosclerotic CVD. A secondary aim was to examine changes in risk prediction when CAC score was added and age was removed from risk-prediction models.
In total, the analysis included 4,778 participants aged older than 60 years without atherosclerotic CVD at baseline. All underwent CAC scoring using cardiac CT from 1998 to 2006. The mean age was 70 years, 54% were women and 51% were nonwhite.
A total of 405 CHD events and 228 stroke events occurred during 11 years of follow-up.
Compared with age, the researchers reported a greater association between CAC score and incident CHD (C statistic, 0.733 vs 0.69; C statistics difference, 0.043; 95% CI of difference, 0.009-0.075) and modestly improved prediction for incident stroke (C statistic, 0.695 vs 0.67; C statistics difference, 0.025; 95% CI of difference, 0.015 to 0.064), according to the results.
In models that included traditional CV risk factors, when the researchers added CAC score and removed age, it resulted in improved discrimination for incident CHD (C statistic, 0.735 vs 0.703; C statistics difference, 0.032; 95% CI of difference, 0.002-0.062). This change to the risk-prediction model, however, did not resulted in improved discrimination for stroke, according to findings.
Among patients with an atherosclerotic CVD event, CAC score provided higher category-free net reclassification improvement than age (0.39; 95% CI, 0.312-0.467 vs. 0.08; 95% CI, –0.001 to 0.181). This was also associated with more accurate reclassification of atherosclerotic CVD event risk, according to the researchers.
When the researchers analyzed this association using two European cohorts (n = 4,990), the results were similar.
“Clinical trials are needed to assess whether CAC score can help refine treatment decisions and subsequently reduce unnecessary medical expenditure and adverse effects of statins in increase treatment efficiency in older adults,” Yano and colleagues wrote. – by Dave Quaile
Disclosure: The authors report no relevant financial disclosures.
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