Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.
Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.
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DOI：
10.1016/j.jacc.2015.10.058
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发表时间：
2016-01-19
影响因子：
24
通讯作者：
Herrington DM
中科院分区：
文献类型：
--
作者：
Yeboah J;Young R;McClelland RL;Delaney JC;Polonsky TS;Dawood FZ;Blaha MJ;Miedema MD;Sibley CT;Carr JJ;Burke GL;Goff DC Jr;Psaty BM;Greenland P;Herrington DM
The improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines to the atherosclerotic cardiovascular disease (ASCVD) risk estimator (pooled cohort equation [PCE]) is untested. We assessed the predictive accuracy and improvement in reclassification gained by the addition of coronary artery calcium (CAC) score, ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP), and family history (FH) of ASCVD to the PCE in participants of the MESA (Multi Ethnic Study of Atherosclerosis). The PCE was calibrated (cPCE) and used for this analysis. Cox proportional hazard model, Harrell's C-statistics, and net reclassification improvement analyses were used. ASCVD was defined as myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke. Of 6,814 MESA participants not on statins at baseline, 5,185 had complete data and were included in this analysis. Mean age was 61years; 53.1% were women, 9.8% diabetic, and 13.6% current smokers. After 10 years of follow-up, 320 (6.2%) ASCVD events occurred. CAC, ABI, and FH were independent predictors of ASCVD events in the multivariable Cox models. CAC modestly improved the Harrell's C-statistic (0.74 vs. 0.76; p = 0.04) while ABI, hsCRP, and FH showed no improvement in Harrell's C-statistic when added to the cPCE. CAC, ABI, and FH are independent predictors of ASCVD events. CAC modestly improved the discriminative ability of the cPCE best compared with other nontraditional risk markers.
