Arterial age as a substitute for chronological age in the AGLA risk function could improve coronary risk prediction

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Risk Stratification

Background:

• Coronary risk charts like the Swiss Arbeitsgruppe Lipide und Atherosklerose (AGLA) have limited sensitivity for predicting future myocardial infarction.
• Arterial age (aa) is explored as a potential surrogate for chronological age (ca) to enhance risk prediction.

Purpose of the Study:

• To evaluate the performance of arterial age (aa) as a predictor of myocardial infarction compared to chronological age (ca).
• To assess if arterial age can improve the accuracy of the AGLA coronary risk function.

Main Methods:

• Carotid plaque burden was quantified using total plaque area (TPA) via ultrasound in a derivation cohort (n=1500).
• An exponential function derived sex-specific formulas for arterial age based on TPA.
• The predictive ability of AGLA using chronological age (AGLAca) and arterial age (AGLAaa) was validated in an external cohort (n=684) for detecting myocardial infarctions.

Main Results:

• Arterial age formulas were established: men y = 5.4175e0.0426x, women y = 4.1942e0.0392x.
• Receiver operating characteristic (ROC) analysis showed a significantly higher area under the curve for AGLAaa (0.78) compared to AGLAca (0.65).
• Cox regression analysis confirmed AGLAaa's significant association with event-free survival (p=0.0003), unlike AGLAca.

Conclusions:

• Arterial age derived from carotid plaque total plaque area (TPA) can effectively replace chronological age in the AGLA coronary risk function.
• The use of arterial age demonstrates superior predictive performance for myocardial infarction.
• Further research is warranted to validate these findings externally and assess the cost-effectiveness of ultrasound imaging for arterial age determination.