This article is more than 5 years old. Information may no longer be current.
Markers identified for improved assessment of intermediate CV risk
Click Here to Manage Email Alerts
The process of classifying patients as high-, intermediate- or low-risk for cardiovascular disease using the Framingham risk score or other models predictive of CVD risk has been established. However, according to researchers, the intermediate-risk group often contains lower-risk patients who could benefit from lifestyle interventions. To improve assessment of patients in this group, researchers have identified six of the most novel risk markers.
Joseph Yeboah, MD, MS, of the Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues examined the improvements in CHD/CVD prediction accuracy and reclassification to high- and low-risk categories using six markers: carotid intima-media thickness (CIMT), coronary artery calcium (CAC), flow-mediated dilation (FMD), ankle-brachial index (ABI), high-sensitivity CRP, and family histories of CHD in asymptomatic adults classified as intermediate-risk in the Multi-Ethnic Study of Atherosclerosis (MESA).
Researchers extracted data from MESA and analyzed 6,814 of the patients enrolled from six US field centers. Of the 6,814 patients in the study, 1,330 were classified as intermediate risk, without diabetes, and had complete data on all six markers.
Main outcome measures included incident CHD, defined as MI, angina followed by revascularization, resuscitated cardiac arrest or CHD death, the researchers wrote. Incident CHD also included stroke or CVD death.
According to data, 94 patients experienced a CHD event and 123 had CVD events after a 7.6-year median follow-up. Additional data found that CAC (HR=2.60; 95% CI, 1.94-3.50), ABI (HR=0.79; 95% CI, 0.66-0.95), high-sensitivity CRP (HR=1.28; 95% CI, 1-1.64), and family history (HR=2.18; 95% CI, 1.38-3.42) were independently linked to incident CHD in multivariable analyses.
Therefore, Yeboah and colleagues determined that CAC, ABI, high-sensitivity CRP and family history were independent predictors of incident CHD/CVD beyond traditional risk factors. However, CAC had the highest improvement in both area under the curve and net reclassification improvement when added to the Framingham risk score/Reynolds score.
Peter W.F. Wilson
J. Michael Gaziano, MD, MPH, of Boston VA Healthcare System, Brigham and Women’s Hospital and Harvard Medical School, and Endocrine Today Editorial Board member Peter W.F. Wilson, MD, of Atlanta VA Medical Center and Emory Clinical Cardiovascular Research Institute, wrote in an accompanying editorial that there are several possibilities in reassessing vascular disease risk.
“[CAC] score appears to augment the risk assessment process but may have limited utility in terms of tracking an individual patient’s vascular risk because it is unlikely that CAC imaging will be tracked over time,” Gaziano and Wilson wrote.
Furthermore, they said the limitation may change in the future as non-ionizing imaging methods are established to determine the atherosclerotic burden.
For more information:
Gaziano JM. JAMA. 2012;308:816-817.
Yeboah J. JAMA. 2012;308:788-795.
Disclosure: Drs. Yeboah, Gaziano and Wilson report no relevant financial disclosures. See the full study for a list of disclosures.
Perspective
Back to Top
Joseph S. Alpert, MD
This is further confirmation of much work done earlier and should not change the recommendations of the recent American College of Cardiology/American Heart Association guideline on patients with asymptomatic coronary artery disease. The first step in screening patients for CAD is a good history with respect to symptoms, risk factors and family history. This leads to the Framingham Risk score, which is still the gold standard for CAD risk assessment. When there are circumstances that lead the clinician to believe that this first assessment is not adequate or confusing, then other risk markers such as coronary artery calcium are indicated. I do not favor, nor did the majority of participants on the asymptomatic CAD guideline committee favor, going straight to coronary calcium determination without the prior careful history and Framingham Risk Score calculation.
Click Here to Manage Email Alerts