Comparative Value of Coronary Artery Calcium and Multiple Blood Biomarkers for Prognostication of Cardiovascular Events

Study Questions:

What is the added value of coronary artery calcium (CAC) scoring for prediction of cardiovascular (CV) events compared to a panel of plasma biomarkers?


A total of 1,286 asymptomatic participants without known coronary artery disease (CAD) were followed 4.1 ± 0.4 years for the primary outcome of combined CV disease (CVD) (cardiac death, myocardial infarction [MI], stroke, and late target vessel revascularization). CAC was calculated by the method of Agatston. Biomarkers measured were C-reactive protein, interleukin-6, myeloperoxidase, B-type natriuretic peptide, and plasminogen activator-1.


Thirty-five participants developed CVD events including cardiac deaths (6%), MI (23%), strokes (17%), and late revascularizations (54%). After adjusting for Framingham risk score (FRS), presence of log CAC beyond FRS was associated with increased hazards for CVD events (hazard ratio, 1.7; p < 0.001). Multiple biomarker score was also associated with increased risk beyond FRS (hazard ratio, 2.1; p = 0.02) per 1-U increase in score; however, the c-statistic did not increase significantly (0.75; p = 0.32). The c-statistic increased when log CAC was incorporated into FRS without or with multiple biomarker score (c-statistic, 0.84; p = 0.003 and p = 0.008). Addition of CAC to risk factors showed significant reclassification improvement (p = 0.007), whereas addition of multiple biomarker score did not.


The authors concluded that in asymptomatic subjects without known CVD, addition of CAC, but not biomarkers, substantially improved risk reclassification for future CVD events beyond traditional risk factors.


CAC scoring is appealing for risk stratification because it is a noninvasive, direct measure of a vasculopathic process. This study demonstrates that CAC scoring may add additional prognostic information to conventional risk scoring methods, and performs better than a panel of plasma biomarkers. CAC scoring may be useful if it proves to be a cost-effective means to identify additional subjects who will achieve benefit from preventive therapies such as statins.

Clinical Topics: Dyslipidemia, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins

Keywords: Prognosis, Natriuretic Peptides, Coronary Artery Disease, Myocardial Infarction, Stroke, C-Reactive Protein, Biological Markers, Plasminogen, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Interleukin-6, Peroxidase

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