Beyond Coronary Calcification, Family History, and C-Reactive Protein: Cholesterol Efflux Capacity and Cardiovascular Risk Prediction.
Beyond Coronary Calcification, Family History, and C-Reactive Protein: Cholesterol Efflux Capacity and Cardiovascular Risk Prediction.
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DOI：
10.1016/j.jacc.2016.03.538
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发表时间：
2016-05-31
影响因子：
24
通讯作者：
Rohatgi A
中科院分区：
文献类型：
--
作者：
Mody P;Joshi PH;Khera A;Ayers CR;Rohatgi A
Cholesterol efflux capacity (CEC), a key step in the reverse cholesterol transport pathway, is independently associated with atherosclerotic cardiovascular disease (ASCVD). However, whether it predicts ASCVD beyond validated novel risk markers is unknown. We assessed whether CEC improved ACSVD risk prediction beyond coronary artery calcium (CAC), family history (FH) and high sensitivity C-reactive protein (hs-CRP). CEC, CAC, self-reported FH, and hs-CRP were assessed among participants without baseline ASCVD enrolled in the Dallas Heart Study (DHS). ASCVD was defined as first nonfatal myocardial infarction (MI) or stroke, coronary revascularization, or cardiovascular death assessed over a median 9.4 years. Risk prediction was assessed using various modeling techniques and improvements in the C-statistic, Integrated Discrimination Index (IDI), and Net Reclassification Index (NRI). The mean age of the population (N = 1,972) was 45, 52% had CAC (> 0), 31% had FH and 58% had elevated hs-CRP (≥ 2 mg/L). CEC > median was associated with 50% reduced incidence of ASCVD in those with CAC (5.4% vs. 10.5%, p = 0.003), FH (5.8% vs. 10%, p = 0.05) and elevated hs-CRP (3.8% vs. 7.9%, p = 0.004). CEC improved all metrics of discrimination and reclassification when added to CAC (C-statistic p = 0.004; IDI p = 0.02, NRI = 0.38 [95%CI 0.13–0.53]), FH (C-statistic p = 0.006; IDI p = 0.008, NRI = 0.38 [95%CI 0.13- 0.55]), or hs-CRP (C-statistic p = 0.008; IDI p = 0.02, NRI = 0.36 [95%CI 0.12–0.52]). CEC improves ASCVD risk prediction beyond CAC, FH, and hs-CRP and warrants consideration as a novel ASCVD risk marker.
