The association of Framingham and reynolds risk scores with incidence and progression of coronary artery calcification in MESA (multi-ethnic study of atherosclerosis)

Andrew P. Defilippis, Michael Blaha, Chiadi Ericson Ndumele, Matthew J. Budoff, Donald M. Lloyd-Jones, Robyn L. McClelland, Susan G. Lakoski, Mary Cushman, Nathan D. Wong, Roger S Blumenthal, Joao Lima, Khurram Nasir

Research output: Contribution to journalArticle

Abstract

Objectives: The purpose of this study was to compare the association of the Framingham risk score (FRS) and Reynolds risk score (RRS) with subclinical atherosclerosis, assessed by incidence and progression of coronary artery calcium (CAC). Background: The comparative effectiveness of competing risk algorithms for identifying subclinical atherosclerosis is unknown. Methods: MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 participants free of baseline cardiovascular disease. All participants underwent risk factor assessment, as well as baseline and follow-up CAC testing. We assessed the performance of the FRS and RRS to predict CAC incidence and progression using relative risk and robust linear regression. Results: The study population included 5,140 individuals (mean age 61 ± 10 years, 47% males, mean follow-up: 3.1 ± 1.3 years). Among 53% of subjects (n = 2,729) with no baseline CAC, 18% (n = 510) developed incident CAC. Both the FRS and RRS were significantly predictive of incident CAC (relative risk: 1.40 [95% confidence interval (CI): 1.29 to 1.52] and 1.41 [95% CI: 1.30 to 1.54] per 5% increase in risk, respectively) and CAC progression (mean CAC score change: 6.92 [95% CI: 5.31 to 8.54] and 6.82 [95% CI: 5.51 to 8.14] per 5% increase). Discordance in risk category classification (10% per 10-year coronary heart disease risk) occurred in 13.7%, with only the RRS consistently adding predictive value for incidence and progression of CAC. These subclinical atherosclerosis findings are supported by a coronary heart disease events analysis over a mean follow-up of 5.6 ± 0.7 years. Conclusions: Both the RRS and FRS predict onset and progression of subclinical atherosclerosis. However, the RRS may provide additional predictive information when discordance between the scoring systems exists.

Original languageEnglish (US)
Pages (from-to)2076-2083
Number of pages8
JournalJournal of the American College of Cardiology
Volume58
Issue number20
DOIs
StatePublished - Nov 8 2011

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Atherosclerosis
Coronary Vessels
Incidence
Calcium
Confidence Intervals
Coronary Disease
Linear Models
Cohort Studies
Cardiovascular Diseases
Prospective Studies

Keywords

  • calcium progression
  • coronary artery
  • Framingham risk score
  • Reynolds risk score
  • risk prediction
  • subclinical atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The association of Framingham and reynolds risk scores with incidence and progression of coronary artery calcification in MESA (multi-ethnic study of atherosclerosis). / Defilippis, Andrew P.; Blaha, Michael; Ndumele, Chiadi Ericson; Budoff, Matthew J.; Lloyd-Jones, Donald M.; McClelland, Robyn L.; Lakoski, Susan G.; Cushman, Mary; Wong, Nathan D.; Blumenthal, Roger S; Lima, Joao; Nasir, Khurram.

In: Journal of the American College of Cardiology, Vol. 58, No. 20, 08.11.2011, p. 2076-2083.

Research output: Contribution to journalArticle

Defilippis, Andrew P. ; Blaha, Michael ; Ndumele, Chiadi Ericson ; Budoff, Matthew J. ; Lloyd-Jones, Donald M. ; McClelland, Robyn L. ; Lakoski, Susan G. ; Cushman, Mary ; Wong, Nathan D. ; Blumenthal, Roger S ; Lima, Joao ; Nasir, Khurram. / The association of Framingham and reynolds risk scores with incidence and progression of coronary artery calcification in MESA (multi-ethnic study of atherosclerosis). In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 20. pp. 2076-2083.
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abstract = "Objectives: The purpose of this study was to compare the association of the Framingham risk score (FRS) and Reynolds risk score (RRS) with subclinical atherosclerosis, assessed by incidence and progression of coronary artery calcium (CAC). Background: The comparative effectiveness of competing risk algorithms for identifying subclinical atherosclerosis is unknown. Methods: MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 participants free of baseline cardiovascular disease. All participants underwent risk factor assessment, as well as baseline and follow-up CAC testing. We assessed the performance of the FRS and RRS to predict CAC incidence and progression using relative risk and robust linear regression. Results: The study population included 5,140 individuals (mean age 61 ± 10 years, 47{\%} males, mean follow-up: 3.1 ± 1.3 years). Among 53{\%} of subjects (n = 2,729) with no baseline CAC, 18{\%} (n = 510) developed incident CAC. Both the FRS and RRS were significantly predictive of incident CAC (relative risk: 1.40 [95{\%} confidence interval (CI): 1.29 to 1.52] and 1.41 [95{\%} CI: 1.30 to 1.54] per 5{\%} increase in risk, respectively) and CAC progression (mean CAC score change: 6.92 [95{\%} CI: 5.31 to 8.54] and 6.82 [95{\%} CI: 5.51 to 8.14] per 5{\%} increase). Discordance in risk category classification (10{\%} per 10-year coronary heart disease risk) occurred in 13.7{\%}, with only the RRS consistently adding predictive value for incidence and progression of CAC. These subclinical atherosclerosis findings are supported by a coronary heart disease events analysis over a mean follow-up of 5.6 ± 0.7 years. Conclusions: Both the RRS and FRS predict onset and progression of subclinical atherosclerosis. However, the RRS may provide additional predictive information when discordance between the scoring systems exists.",
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T1 - The association of Framingham and reynolds risk scores with incidence and progression of coronary artery calcification in MESA (multi-ethnic study of atherosclerosis)

AU - Defilippis, Andrew P.

AU - Blaha, Michael

AU - Ndumele, Chiadi Ericson

AU - Budoff, Matthew J.

AU - Lloyd-Jones, Donald M.

AU - McClelland, Robyn L.

AU - Lakoski, Susan G.

AU - Cushman, Mary

AU - Wong, Nathan D.

AU - Blumenthal, Roger S

AU - Lima, Joao

AU - Nasir, Khurram

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N2 - Objectives: The purpose of this study was to compare the association of the Framingham risk score (FRS) and Reynolds risk score (RRS) with subclinical atherosclerosis, assessed by incidence and progression of coronary artery calcium (CAC). Background: The comparative effectiveness of competing risk algorithms for identifying subclinical atherosclerosis is unknown. Methods: MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 participants free of baseline cardiovascular disease. All participants underwent risk factor assessment, as well as baseline and follow-up CAC testing. We assessed the performance of the FRS and RRS to predict CAC incidence and progression using relative risk and robust linear regression. Results: The study population included 5,140 individuals (mean age 61 ± 10 years, 47% males, mean follow-up: 3.1 ± 1.3 years). Among 53% of subjects (n = 2,729) with no baseline CAC, 18% (n = 510) developed incident CAC. Both the FRS and RRS were significantly predictive of incident CAC (relative risk: 1.40 [95% confidence interval (CI): 1.29 to 1.52] and 1.41 [95% CI: 1.30 to 1.54] per 5% increase in risk, respectively) and CAC progression (mean CAC score change: 6.92 [95% CI: 5.31 to 8.54] and 6.82 [95% CI: 5.51 to 8.14] per 5% increase). Discordance in risk category classification (10% per 10-year coronary heart disease risk) occurred in 13.7%, with only the RRS consistently adding predictive value for incidence and progression of CAC. These subclinical atherosclerosis findings are supported by a coronary heart disease events analysis over a mean follow-up of 5.6 ± 0.7 years. Conclusions: Both the RRS and FRS predict onset and progression of subclinical atherosclerosis. However, the RRS may provide additional predictive information when discordance between the scoring systems exists.

AB - Objectives: The purpose of this study was to compare the association of the Framingham risk score (FRS) and Reynolds risk score (RRS) with subclinical atherosclerosis, assessed by incidence and progression of coronary artery calcium (CAC). Background: The comparative effectiveness of competing risk algorithms for identifying subclinical atherosclerosis is unknown. Methods: MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 participants free of baseline cardiovascular disease. All participants underwent risk factor assessment, as well as baseline and follow-up CAC testing. We assessed the performance of the FRS and RRS to predict CAC incidence and progression using relative risk and robust linear regression. Results: The study population included 5,140 individuals (mean age 61 ± 10 years, 47% males, mean follow-up: 3.1 ± 1.3 years). Among 53% of subjects (n = 2,729) with no baseline CAC, 18% (n = 510) developed incident CAC. Both the FRS and RRS were significantly predictive of incident CAC (relative risk: 1.40 [95% confidence interval (CI): 1.29 to 1.52] and 1.41 [95% CI: 1.30 to 1.54] per 5% increase in risk, respectively) and CAC progression (mean CAC score change: 6.92 [95% CI: 5.31 to 8.54] and 6.82 [95% CI: 5.51 to 8.14] per 5% increase). Discordance in risk category classification (10% per 10-year coronary heart disease risk) occurred in 13.7%, with only the RRS consistently adding predictive value for incidence and progression of CAC. These subclinical atherosclerosis findings are supported by a coronary heart disease events analysis over a mean follow-up of 5.6 ± 0.7 years. Conclusions: Both the RRS and FRS predict onset and progression of subclinical atherosclerosis. However, the RRS may provide additional predictive information when discordance between the scoring systems exists.

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KW - Framingham risk score

KW - Reynolds risk score

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