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Published on: September 26, 2018

Differences in absolute risk of cardiovascular events using risk-refinement tests: a systematic analysis of four

Emil M deGoma1, Richard L Dunbar, Douglas Jacoby

  • 1Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA. emil.deGoma@uphs.upenn.edu

Atherosclerosis
|January 26, 2013
PubMed

Insights

Cardiovascular risk assessment using C-reactive protein (CRP), carotid intima-media thickness (CIMT), and coronary artery calcium (CAC) thresholds can significantly alter absolute risk calculations. Coronary artery calcium (CAC) showed the greatest impact on absolute risk predictions.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Medical Diagnostics

Background:

  • Current cardiovascular risk assessment guidelines utilize C-reactive protein (CRP), carotid intima-media thickness (CIMT), and coronary artery calcium (CAC) in select populations.
  • Thresholds for higher and lower cardiovascular risk are defined for these tests, but their impact on absolute global risk is not fully understood.

Purpose of the Study:

  • To evaluate the effect of established risk thresholds for CRP, CIMT, and CAC on absolute cardiovascular risk estimates.
  • To compare the impact of these risk refinement tests when incorporated into different validated risk prediction equations.

Main Methods:

  • Systematic permutation of risk factors to generate 10-year risk estimates using Framingham, MESA, ARIC, and Reynolds risk scores.
  • Defined low, high, and very-high risk values for CAC (Agatston units), CIMT (percentiles), and hsCRP (mg/L).

Main Results:

  • Incorporating coronary artery calcium (CAC) values into the MESA risk score led to more substantial changes in absolute risk compared to the Framingham risk score.
  • The impact of CAC on absolute risk was greater than that of CIMT or hsCRP when using ARIC or Reynolds risk scores.

Conclusions:

  • Designated low, high, and very-high risk values for CAC, CIMT, and hsCRP result in significantly different absolute cardiovascular risk levels when applied within validated risk equations.
  • Calculating absolute cardiovascular risk using validated risk equations is recommended over relying solely on risk-marker thresholds derived from relative risk estimates.
Abstract

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