Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 58, Issue 20, Pages 2076-2083Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2011.08.022
Keywords
calcium progression; coronary artery; Framingham risk score; Reynolds risk score; risk prediction; subclinical atherosclerosis
Categories
Funding
- National Heart, Lung and Blood Institute [R01 HL071739, N01-HC-95159, N01-HC-95169]
- National Research Service [T32-HL-07227]
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Objectives The purpose of this study was to compare the association of the Framingham risk score (FRS) and Reynolds risk score (RRS) with subclinical atherosclerosis, assessed by incidence and progression of coronary artery calcium (CAC). Background The comparative effectiveness of competing risk algorithms for identifying subclinical atherosclerosis is unknown. Methods MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 participants free of baseline cardiovascular disease. All participants underwent risk factor assessment, as well as baseline and follow-up CAC testing. We assessed the performance of the FRS and RRS to predict CAC incidence and progression using relative risk and robust linear regression. Results The study population included 5,140 individuals (mean age 61 +/- 10 years, 47% males, mean follow-up: 3.1 +/- 1.3 years). Among 53% of subjects (n = 2,729) with no baseline CAC, 18% (n = 510) developed incident CAC. Both the FRS and RRS were significantly predictive of incident CAC (relative risk: 1.40 [95% confidence interval (CI): 1.29 to 1.52] and 1.41 [95% CI: 1.30 to 1.54] per 5% increase in risk, respectively) and CAC progression (mean CAC score change: 6.92 [95% CI: 5.31 to 8.54] and 6.82 [95% CI: 5.51 to 8.14] per 5% increase). Discordance in risk category classification (<10% or >10% per 10-year coronary heart disease risk) occurred in 13.7%, with only the RRS consistently adding predictive value for incidence and progression of CAC. These subclinical atherosclerosis findings are supported by a coronary heart disease events analysis over a mean follow-up of 5.6 +/- 0.7 years. Conclusions Both the RRS and FRS predict onset and progression of subclinical atherosclerosis. However, the RRS may provide additional predictive information when discordance between the scoring systems exists. (J Am Coll Cardiol 2011;58:2076-83) (C) 2011 by the American College of Cardiology Foundation
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