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CAC scores, self-reported health status may improve CV risk prediction
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Coronary artery calcification score and self-rated health status were poorly connected and may in fact be complementary when predicting CV risk, according to a study published in JAMA Network Open.
“The combination of [self-rated health] and CAC score may provide similar risk discrimination to the [Pooled Cohort Equations] and may be a useful and parsimonious approach to initial risk prediction in screening programs, in research studies and, selectively, in clinical practice,” Olusola A. Orimoloye, MD, MPH, postdoctoral fellow at the Ciccarone Center for the Prevention of Cardiovascular Disease at The Johns Hopkins University School of Medicine, and colleagues wrote.
MESA data
Researchers analyzed data from 6,764 participants (mean age, 62 years; 53% women) from the Multi-Ethnic Study of Atherosclerosis aged 45 to 84 years who were free from CVD at baseline. Participants were categorized based on their self-rated health: excellent (n = 1,073), very good (n = 2,266), good (n = 2,792) and poor/fair (n = 633).
Two CT scans were performed at baseline for CAC scoring. Several questionnaires were completed to collect information on sociodemographic variables, alcohol consumption, smoking status, medical conditions, family history of CVD, physical activity, depression and diet.
Follow-up was conducted for a median of 13.2 years for CHD events, defined as resuscitated cardiac arrest, MI or CHD death, and CVD events, which included CHD events plus fatal and nonfatal stroke.
Participants who reported to have very good and excellent health were more likely to be men (48.6% vs. 52.4%, respectively), were younger (61.1 years for both groups), and more likely to have a high school education (89.5% vs. 94.4%, respectively) than the others in the cohort. Poor/fair health was more likely to be reported by Hispanic (40.8%) and black participants (41.2%). Self-rated health was not associated with the degree (P = .86) or presence (P = .84) of CAC, nor did it correlate with CAC (r = –0.007; P = .57).
During follow-up, there were 637 hard CVD events, 1,161 deaths and 405 hard CHD events.
Reduced risk for events
Compared with patients who self-reported poor/fair health, those who reported excellent health had a 42% lower risk for CHD (HR = 0.58; 95% CI, 0.37-0.9) and a 45% lower risk for CVD (HR = 0.55; 95% CI, 0.39-0.77) after adjustment for sex, age, CAC and race/ethnicity.
Patients who reported excellent health and had any CAC had an increased risk for CVD (HR = 6.5; 95% CI, 2.7-15.6) and CHD (HR = 6.19; 95% CI, 2.1-18.3) compared with those who had a CAC score of 0.
Adding self-rated health to CAC scores significantly improved C-statistics for CVD events (0.693 vs. 0.706; P < .001), CHD events (0.725 vs. 0.734; P = .007) and all-cause mortality (0.685 vs. 0.707; P < .001). The addition of excellent, very good, good, fair and poor rating to both CAC and atherosclerotic CVD risk scores did not improve C-statistics for CVD events (0.718 vs. 0.717; P = .74), CHD events (0.712 vs. 0.711; P = .83) or all-cause mortality (0.777 vs. 0.777; P = .8).
“Under the rubric of the new 2018 ACC/AHA risk prediction guidelines, we propose that poor [self-rated health] may be useful as a risk enhancer in patients at borderline to intermediate risk (5% to 20% ASCVD), which may suggest a potential need for more definitive risk assessment using tools such as CAC scoring,” Orimoloye and colleagues wrote. “Importantly, however, excellent [self-rated health] may not be a reliable marker of very low risk in a patient.” – by Darlene Dobkowski
Disclosure: Orimoloye reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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