Coronary Artery Calcium Superior Risk Marker for CHD

Coronary artery calcium (CAC), ankle-brachial index (ABI), high-sensitivity C-reactive protein (CRP), and family history were independent predictors of incident coronary heart disease (CHD)/cardiovascular disease (CVD) beyond traditional risk factors. 

However, each had varying degrees of improvement in discrimination and risk classification within intermediate-risk individuals, according to a study published in The Journal of the American Medical Association (JAMA) on Aug. 21.

The study, which looked at intermediate-risk participants (FRS _5%-_20%) in the Multi-Ethnic Study of Atherosclerosis (MESA), found that overall CAC, ABI, high-sensitivity CRP, and family history were independently associated with incident CHD in multivariable analyses (HR, 2.60 [95% CI, 1.94-3.50]; HR, 0.79 [95% CI, 0.66-0.95]; HR, 1.28 [95% CI, 1.00-1.64]; and HR, 2.18 [95% CI, 1.38-3.42], respectively). CAC had the highest improvement in both the area under the receiver operator characteristic curves and net reclassification improvement when added to the Framingham Risk Score/Reynolds score, while brachial flow–mediated dilation had the least.  “Carotid intima-media thickness and brachial flow-mediated dilation were not associated with incident CHD in multivariable analyses,” according to the authors.

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Moving forward, additional research is warranted to explore further both the costs and benefits of CAC screening in intermediate-risk individuals, the authors said. They also noted that even though the study “indicates considerable superiority of CAC over several risk markers for risk prediction of CHD and CVD, several other factors should be considered before making broad recommendations about incorporation of CAC into primary prevention screening strategies.”

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