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Steps to developing a DXA-based risk score for cardiovascular outcomes among older adults: the health, aging, and
Lihui Chen1, Xinran Wang1, Tian-Ze Lin1
1Global Health Research Center, Duke Kunshan University, Academic Building 3038, 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.
Insights
This study developed a body composition risk score using Dual-energy X-ray absorptiometry (DXA) to improve cardiovascular disease (CVD) prediction in older adults. Integrating DXA data with the Framingham Risk Score (FRS) enhanced CVD risk stratification.
Area of Science:
- Gerontology
- Epidemiology
- Medical Imaging
Background:
- Cardiovascular disease (CVD) poses a significant global health burden, necessitating improved risk prediction strategies.
- Epidemiological studies have extensively investigated CVD risk factors, yet prediction accuracy in older adults requires enhancement.
- Body composition, particularly as assessed by Dual-energy X-ray absorptiometry (DXA), offers potential novel insights into CVD risk.
Purpose of the Study:
- To develop and validate a novel body composition-based risk score for cardiovascular disease (CVD).
- To integrate this new risk score with the established Framingham Risk Score (FRS) to enhance CVD prediction accuracy.
- To evaluate the performance of the integrated model in well-functioning older adults.
Main Methods:
- Utilized data from 1882 older adults in the Health, Aging and Body Composition (Health ABC) study.
- Screened body composition variables using Dual-energy X-ray absorptiometry (DXA).
- Developed and compared three risk prediction models: 4-DXA, refit FRS, and refit FRS plus 4-DXA.
Main Results:
- The refit FRS plus 4-DXA model demonstrated a slightly improved C-statistic (0.63) compared to the refit FRS (0.62) and the 4-DXA model (0.58).
- The integrated model showed improvements in discrimination slope (0.053), net reclassification index (0.098), and integrated discrimination index (0.013) over the refit FRS.
- These metrics indicate enhanced accuracy in predicting cardiovascular outcomes when incorporating DXA-derived body composition data.
Conclusions:
- A body composition-based risk score, when integrated with the FRS, offers improved cardiovascular disease risk stratification in older adults.
- Dual-energy X-ray absorptiometry (DXA)-based indices warrant greater attention in clinical settings for cardiovascular risk assessment.
- Further research is recommended to validate this risk score in diverse populations and explore additional CVD risk factors.
Abstract:
Cardiovascular disease (CVD) is a major chronic disease worldwide and its risk factors have long been investigating in epidemiological studies. Our study aims to develop a body composition-based risk score and integrate it into the Framingham Risk Score (FRS) to improve CVD prediction among well-functioning older adults. We included 1882 older adults from the Health, Aging and Body Composition (Health ABC) study to screen body composition variables obtained from the Dual-energy X-ray absorptiometry (DXA). Three models were developed and compared: the 4-DXA model, the refit FRS, and the refit FRS plus 4-DXA model. C-statistics were 0.62 (95% CI: 0.59, 0.65) for the refit FRS, 0.58 (95% CI: 0.55, 0.61) for the 4-DXA model, and 0.63 (95% CI: 0.60, 0.66) for the refit FRS plus 4-DXA model. Compared to the refit FRS, the refit FRS plus 4-DXA model slightly improved CVD outcome prediction as the discrimination slope, net reclassification index, and the integrated discrimination index were 0.053 (95% CI: 0.041, 0.066), 0.098 (95% CI = - 0.0033, 0.20) and 0.013 (95% CI: 0.0069-0.019). This study provides a model for more accurate risk stratification and draws more attention on DXA-based indices in the clinical setting. It also encourages further research in validating the developed risk score in more diverse population and in investigating a broader range of CVD risk factors.
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