Predictive value of updating Framingham risk scores with novel risk markers in the U.S. general population
Bart S Ferket1, Bob J H van Kempen1, M G Myriam Hunink2
1Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands ; Department of Radiology, Erasmus MC, Rotterdam, the Netherlands.
Insights
The CT coronary calcium score (CTCS) significantly improves cardiovascular risk assessment in the U.S. general population, particularly for intermediate-risk individuals. Other novel markers showed limited predictive value.
Area of Science:
- Cardiovascular disease risk assessment
- Preventive cardiology
- Public health
Background:
- Novel risk markers like CTCS, cIMT, CRP, and ABI show promise for cardiovascular risk assessment.
- Their predictive value in the U.S. general population remains uncertain.
Purpose of the Study:
- To estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population.
- To assess the impact of these markers on cardiovascular risk prediction.
Main Methods:
- Utilized data from 3,736 asymptomatic U.S. adults (aged ≥40) from NHANES 2003-2004.
- Calculated 10-year cardiovascular risks with and without CTCS, cIMT, CRP, and ABI.
- Assessed risk reclassification and C-statistics using microsimulation.
Main Results:
- CT coronary calcium score (CTCS) demonstrated the highest net reclassification improvement (0.10) for 10-year CVD risk.
- CTCS increased the C-statistic for CVD risk prediction from 0.82 to 0.84.
- Risk reclassification was most significant in intermediate-risk individuals with CTCS.
Conclusions:
- CTCS offers significant incremental predictive value for cardiovascular risk in the U.S. general population.
- CTCS is particularly beneficial for refining risk assessment in intermediate-risk individuals.
- Future research should consider cost-effectiveness of novel cardiovascular risk assessment strategies.
Background:
According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C- reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U.S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population.
Methods And Findings:
Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56±11 years, 48% male), 70% (80%) were at low (<10%), 19% (14%) at intermediate (≥10-<20%), and 11% (6%) at high (≥20%) 10-year CVD (CHD) risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02-0.19). The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01-0.03) with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38%) moved to low and 22% (30%) to high CVD (CHD) risk. Improvements with other novel risk markers were limited.
Conclusions:
Only CTCS appeared to have significant incremental predictive value in the U.S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies.
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