Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment

Joseph Yeboah, Rebekah Young, Robyn L. McClelland, Joseph C. Delaney, Tamar S. Polonsky, Farah Z. Dawood, Michael Blaha, Michael D. Miedema, Christopher T. Sibley, J. Jeffrey Carr, Gregory L. Burke, David C. Goff, Bruce M. Psaty, Philip Greenland, David M. Herrington

Research output: Contribution to journalArticle

Abstract

Background 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. Objectives This study assessed the predictive accuracy and improvement in reclassification gained by the addition of the coronary artery calcium (CAC) score, the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) levels, and family history (FH) of ASCVD to the PCE in participants of MESA (Multi-Ethnic Study of Atherosclerosis). Methods The PCE was calibrated (cPCE) and used for this analysis. The Cox proportional hazards survival model, Harrell's C statistics, and net reclassification improvement analyses were used. ASCVD was defined as myocardial infarction, coronary heart disease-related death, or fatal or nonfatal stroke. Results Of 6,814 MESA participants not prescribed statins at baseline, 5,185 had complete data and were included in this analysis. Their mean age was 61 years; 53.1% were women, 9.8% had diabetes, and 13.6% were current smokers. After 10 years of follow-up, 320 (6.2%) ASCVD events occurred. CAC score, ABI, and FH were independent predictors of ASCVD events in the multivariable Cox models. CAC score modestly improved the Harrell's C statistic (0.74 vs. 0.76; p = 0.04); ABI, hsCRP levels, and FH produced no improvement in Harrell's C statistic when added to the cPCE. Conclusions CAC score, ABI, and FH were independent predictors of ASCVD events. CAC score modestly improved the discriminative ability of the cPCE compared with other nontraditional risk markers.

Original languageEnglish (US)
Pages (from-to)139-147
Number of pages9
JournalJournal of the American College of Cardiology
Volume67
Issue number2
DOIs
StatePublished - Jan 19 2016

Fingerprint

Ankle Brachial Index
Cardiovascular Diseases
Coronary Vessels
Calcium
Proportional Hazards Models
C-Reactive Protein
Atherosclerosis
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Aptitude
Coronary Disease
Stroke
Myocardial Infarction
Cholesterol
Guidelines
Survival

Keywords

  • coronary artery calcium
  • high-sensitivity C-reactive protein
  • Key Words ankle-brachial index
  • pooled cohort equation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Yeboah, J., Young, R., McClelland, R. L., Delaney, J. C., Polonsky, T. S., Dawood, F. Z., ... Herrington, D. M. (2016). Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment. Journal of the American College of Cardiology, 67(2), 139-147. https://doi.org/10.1016/j.jacc.2015.10.058

Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment. / Yeboah, Joseph; Young, Rebekah; McClelland, Robyn L.; Delaney, Joseph C.; Polonsky, Tamar S.; Dawood, Farah Z.; Blaha, Michael; Miedema, Michael D.; Sibley, Christopher T.; Carr, J. Jeffrey; Burke, Gregory L.; Goff, David C.; Psaty, Bruce M.; Greenland, Philip; Herrington, David M.

In: Journal of the American College of Cardiology, Vol. 67, No. 2, 19.01.2016, p. 139-147.

Research output: Contribution to journalArticle

Yeboah, J, Young, R, McClelland, RL, Delaney, JC, Polonsky, TS, Dawood, FZ, Blaha, M, Miedema, MD, Sibley, CT, Carr, JJ, Burke, GL, Goff, DC, Psaty, BM, Greenland, P & Herrington, DM 2016, 'Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment', Journal of the American College of Cardiology, vol. 67, no. 2, pp. 139-147. https://doi.org/10.1016/j.jacc.2015.10.058
Yeboah, Joseph ; Young, Rebekah ; McClelland, Robyn L. ; Delaney, Joseph C. ; Polonsky, Tamar S. ; Dawood, Farah Z. ; Blaha, Michael ; Miedema, Michael D. ; Sibley, Christopher T. ; Carr, J. Jeffrey ; Burke, Gregory L. ; Goff, David C. ; Psaty, Bruce M. ; Greenland, Philip ; Herrington, David M. / Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment. In: Journal of the American College of Cardiology. 2016 ; Vol. 67, No. 2. pp. 139-147.
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AU - Young, Rebekah

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AU - Delaney, Joseph C.

AU - Polonsky, Tamar S.

AU - Dawood, Farah Z.

AU - Blaha, Michael

AU - Miedema, Michael D.

AU - Sibley, Christopher T.

AU - Carr, J. Jeffrey

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