Factors associated with presence and extent of coronary calcium in those predicted to be at low risk according to framingham risk score (from the Multi-Ethnic Study of Atherosclerosis)

Tochi M. Okwuosa, Philip Greenland, Susan G. Lakoski, Hongyan Ning, Joseph Kang, Roger S. Blumenthal, Moyses Szklo, John R. Crouse, Joao A.C. Lima, Kiang Liu, Donald M. Lloyd-Jones

Research output: Contribution to journalArticle

Abstract

Even among asymptomatic persons at low risk (<10%) according to the Framingham risk score, high coronary artery calcium (CAC) scores signify a greater predicted risk of coronary heart disease events. We sought to determine the noninvasive factors (without radiation exposure) significantly associated with CAC in low-risk, asymptomatic persons. In a cross-sectional analysis, we studied 3,046 participants from the Multi-Ethnic Study of Atherosclerosis at a low 10-year predicted risk (Framingham risk score <10%) of coronary heart disease events. Multivariate logistic regression analysis was used to assess the association of novel markers with the presence of any CAC (CAC >0) and advanced CAC (CAC <300). A CAC level of >0 and of <300 was present in 30% and 3.5% of participants, respectively. Factor VIIIc, fibrinogen, and soluble intercellular adhesion molecule were each associated with the presence of CAC (p ≤0.02), and C-reactive protein, D-dimer, and the carotid intima-media thickness with advanced CAC (p ≤0.03). The base model combining the traditional risk factors had excellent discrimination for advanced CAC (C-statistic 0.808). The addition of the 2 best-fit models combining the biomarkers with or without carotid intima-media thickness improved the c-statistic to 0.822 and 0.820, respectively. All 3 models calibrated well but were similar in estimating the individual risk probabilities for advanced CAC (prevalence 9.97%, 10.63%, and 10.10% in the greatest quartiles of predicted probabilities vs 0.26%, 0.26%, and 0.26% in the lowest quartiles, respectively). In conclusion, in low-risk persons, the traditional risk factors alone predicted advanced CAC with high discrimination and calibration. The biomarker combinations with and without carotid intima-media thickness were also significantly associated with advanced CAC; however, the improvement in the prediction and estimation of the clinical risk were modest compared to the traditional risk factors alone.

Original languageEnglish (US)
Pages (from-to)879-885
Number of pages7
JournalAmerican Journal of Cardiology
Volume107
Issue number6
DOIs
StatePublished - Mar 15 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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