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Novel CVD prediction tool integrates CAC score, risk factors
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A novel CVD risk prediction tool combining coronary artery calcium score with traditional risk factors demonstrated good discrimination and calibration, researchers reported in Circulation.
The tool, the Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) calculator, was developed by cardiologists in collaboration with the National Space Biomedical Research Institute to make precise CV risk assessment in astronauts and the general population easier.
“We found that the Astro-CHARM tool significantly improves cardiovascular risk prediction. It will be an important step forward in decision-making for preventive treatments in the general population for people in midlife,” Amit Khera, MD, MSc, professor of internal medicine and director of UT Southwestern’s Preventive Cardiology Program, who holds the Dallas Heart Ball Chair in Hypertension and Heart Disease, said in a press release. “Cardiovascular risk assessment can also be critical in younger populations, particularly those in high-risk occupations.”
Khera and colleagues developed a model with age, sex, systolic BP, total cholesterol, HDL, smoking, diabetes, hypertension treatment, family history of MI, high-sensitivity C-reactive protein and CAC score as variables, and atherosclerotic CVD, defined as fatal or nonfatal MI or stroke, as the outcome.
The model was tested in participants aged 40 to 65 years without prior CVD.
In the derivation cohort of 7,382 people (mean age, 51 years; 45% women; 55% nonwhite), the median CAC score was zero (interquartile range, 0-9) and 304 atherosclerotic CVD events occurred during 10.9 years of follow-up.
The Astro-CHARM tool had a higher C statistic than the traditional risk factor model (0.817 vs. 0.784; P < .0001), Khera and colleagues found.
Use of the Astro-CHARM model vs. the traditional risk factor model resulted in integrated discrimination improvement of 0.0252 and net reclassification improvement of 0.121 (P < .0001), according to the researchers.
In the validation cohort of 2,057 people who had 55 events during follow-up, the Astro-CHARM model showed good discrimination (C statistic = 0.78) and calibration (Nam-D’Agostino X2 = 13.2; P = .16), Khera and colleagues wrote.
“The Astro-CHARM tool is the first integrated [atherosclerotic] CVD risk calculator to incorporate risk factors, including [high-sensitivity] CRP and family history and CAC data,” the researchers wrote. “It improves risk prediction compared with traditional risk factor equations and could be useful in risk-based decision-making for CVD prevention in the middle-aged general population.”
The Astro-CHARM tool is available online at www.astrocharm.org. – by Erik Swain
Disclosure: Khera reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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