TY - JOUR
T1 - Association of coronary artery calcium score vs age with cardiovascular risk in older adults
T2 - An analysis of pooled population-based studies
AU - Yano, Yuichiro
AU - O’Donnell, Christopher J.
AU - Kuller, Lewis
AU - Kavousi, Maryam
AU - Erbel, Raimund
AU - Ning, Hongyan
AU - D’Agostino, Ralph
AU - Newman, Anne B.
AU - Nasir, Khurram
AU - Hofman, Albert
AU - Lehmann, Nils
AU - Dhana, Klodian
AU - Blankstein, Ron
AU - Hoffmann, Udo
AU - Möhlenkamp, Stefan
AU - Massaro, Joseph M.
AU - Mahabadi, Amir Abbas
AU - Lima, Joao A.C.
AU - Ikram, M. Arfan
AU - Jöckel, Karl Heinz
AU - Franco, Oscar H.
AU - Liu, Kiang
AU - Lloyd-Jones, Donald
AU - Greenland, Philip
N1 - Funding Information:
Atherosclerosis was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources. The Framingham Heart Study was supported by contracts N01-HC-25195, HL076784, AG028321, HL070100, HL060040, HL080124, HL071039, HL077447, and HL107385 from the National Heart, Lung, and Blood Institute. The Cardiovascular Health Study was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant U01HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by R01AG023629 from the National Institute on Aging. A full list of principal Cardiovascular Health Study investigators and institutions can be found at chs-nhlbi.org.The Rotterdam Study is funded by Erasmus MC and Erasmus University, Rotterdam, the Netherlands; the Netherlands Organization for Scientific Research ; the Netherlands Organization for the Health Research and Development; the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. Dr Kavousi is supported by the Netherlands Organisation for Scientific Research Innovational Research Incentives Scheme Veni grant (NWO VENI, 91616079). Dr Franco works in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd); Metagenics Inc; and AXA.
Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
PY - 2017/9
Y1 - 2017/9
N2 - IMPORTANCE: Besides age, other discriminators of atherosclerotic cardiovascular disease (ASCVD) risk are needed in older adults. OBJECTIVES: To examine the predictive ability of coronary artery calcium (CAC) score vs age for incident ASCVD and how risk prediction changes by adding CAC score and removing only age from prediction models. DESIGN, SETTING, AND PARTICIPANTS: We conducted an analysis of pooled US population-based studies, including the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Results were compared with 2 European cohorts, the Rotterdam Study and the Heinz Nixdorf Recall Study. Participants underwent CAC scoring between 1998 and 2006 using cardiac computed tomography. The participants included adults older than 60 years without known ASCVD at baseline. EXPOSURES: Coronary artery calcium scores. MAIN OUTCOMES AND MEASURES: Incident ASCVD events including coronary heart disease (CHD) and stroke. RESULTS: The study included 4778 participants from 3 US cohorts, with a mean age of 70.1 years; 2582 (54.0%) were women, and 2431 (50.9%) were nonwhite. Over 11 years of follow-up (44 152 person-years), 405 CHD and 228 stroke events occurred. Coronary artery calcium score (vs age) had a greater association with incident CHD (C statistic, 0.733 vs 0.690; C statistics difference, 0.043; 95% CI of difference, 0.009-0.075) and modestly improved prediction of incident stroke (C statistic, 0.695 vs 0.670; C statistics difference, 0.025; 95% CI of difference, −0.015 to 0.064). Adding CAC score to models including traditional cardiovascular risk factors, with only age being removed, provided improved discrimination for incident CHD (C statistic, 0.735 vs 0.703; C statistics difference, 0.032; 95% CI of difference, 0.002-0.062) but not for stroke. Coronary artery calcium score was more likely than age to provide higher category-free net reclassification improvement among participants who experienced an ASCVD event (0.390; 95% CI, 0.312-0.467 vs 0.08; 95% CI −0.001 to 0.181) and to result in more accurate reclassification of risk for ASCVD events among these individuals. The findings were similar in the 2 European cohorts (n = 4990). CONCLUSIONS AND RELEVANCE: Coronary artery calcium may be an alternative marker besides age to better discriminate between lower and higher CHD risk in older adults. Whether CAC score can assist in guiding the decision to initiate statin treatment for primary prevention in older adults requires further investigation.
AB - IMPORTANCE: Besides age, other discriminators of atherosclerotic cardiovascular disease (ASCVD) risk are needed in older adults. OBJECTIVES: To examine the predictive ability of coronary artery calcium (CAC) score vs age for incident ASCVD and how risk prediction changes by adding CAC score and removing only age from prediction models. DESIGN, SETTING, AND PARTICIPANTS: We conducted an analysis of pooled US population-based studies, including the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Results were compared with 2 European cohorts, the Rotterdam Study and the Heinz Nixdorf Recall Study. Participants underwent CAC scoring between 1998 and 2006 using cardiac computed tomography. The participants included adults older than 60 years without known ASCVD at baseline. EXPOSURES: Coronary artery calcium scores. MAIN OUTCOMES AND MEASURES: Incident ASCVD events including coronary heart disease (CHD) and stroke. RESULTS: The study included 4778 participants from 3 US cohorts, with a mean age of 70.1 years; 2582 (54.0%) were women, and 2431 (50.9%) were nonwhite. Over 11 years of follow-up (44 152 person-years), 405 CHD and 228 stroke events occurred. Coronary artery calcium score (vs age) had a greater association with incident CHD (C statistic, 0.733 vs 0.690; C statistics difference, 0.043; 95% CI of difference, 0.009-0.075) and modestly improved prediction of incident stroke (C statistic, 0.695 vs 0.670; C statistics difference, 0.025; 95% CI of difference, −0.015 to 0.064). Adding CAC score to models including traditional cardiovascular risk factors, with only age being removed, provided improved discrimination for incident CHD (C statistic, 0.735 vs 0.703; C statistics difference, 0.032; 95% CI of difference, 0.002-0.062) but not for stroke. Coronary artery calcium score was more likely than age to provide higher category-free net reclassification improvement among participants who experienced an ASCVD event (0.390; 95% CI, 0.312-0.467 vs 0.08; 95% CI −0.001 to 0.181) and to result in more accurate reclassification of risk for ASCVD events among these individuals. The findings were similar in the 2 European cohorts (n = 4990). CONCLUSIONS AND RELEVANCE: Coronary artery calcium may be an alternative marker besides age to better discriminate between lower and higher CHD risk in older adults. Whether CAC score can assist in guiding the decision to initiate statin treatment for primary prevention in older adults requires further investigation.
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U2 - 10.1001/jamacardio.2017.2498
DO - 10.1001/jamacardio.2017.2498
M3 - Article
C2 - 28746709
AN - SCOPUS:85032262983
SN - 2380-6583
VL - 2
SP - 986
EP - 994
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 9
ER -