10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) with Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study)

Robyn L. McClelland, Neal W. Jorgensen, Matthew Budoff, Michael J. Blaha, Wendy S. Post, Richard A. Kronmal, Diane E. Bild, Steven Shea, Kiang Liu, Karol E. Watson, Aaron R. Folsom, Amit Khera, Colby Ayers, Amir Abbas Mahabadi, Nils Lehmann, Karl Heinz Jöckel, Susanne Moebus, J. Jeffrey Carr, Raimund Erbel, Gregory L. Burke

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200 Scopus citations

Abstract

Background Several studies have demonstrated the tremendous potential of using coronary artery calcium (CAC) in addition to traditional risk factors for coronary heart disease (CHD) risk prediction. However, to date, no risk score incorporating CAC has been developed. Objectives The goal of this study was to derive and validate a novel risk score to estimate 10-year CHD risk using CAC and traditional risk factors. Methods Algorithm development was conducted in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective community-based cohort study of 6,814 participants age 45 to 84 years, who were free of clinical heart disease at baseline and followed for 10 years. MESA is sex balanced and included 39% non-Hispanic whites, 12% Chinese Americans, 28% African Americans, and 22% Hispanic Americans. External validation was conducted in the HNR (Heinz Nixdorf Recall Study) and the DHS (Dallas Heart Study). Results Inclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 vs. 0.75; p < 0.0001). External validation in both the HNR and DHS studies provided evidence of very good discrimination and calibration. Harrell's C-statistic was 0.779 in HNR and 0.816 in DHS. Additionally, the difference in estimated 10-year risk between events and nonevents was approximately 8% to 9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within one-half of a percent of the observed event rate. Conclusions An accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. The MESA risk score, which is available online on the MESA web site for easy use, can be used to aid clinicians when communicating risk to patients and when determining risk-based treatment strategies.

Original languageEnglish (US)
Pages (from-to)1643-1653
Number of pages11
JournalJournal of the American College of Cardiology
Volume66
Issue number15
DOIs
StatePublished - Oct 13 2015

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Keywords

  • atherosclerosis
  • coronary disease
  • epidemiology
  • risk prediction

Cite this

McClelland, R. L., Jorgensen, N. W., Budoff, M., Blaha, M. J., Post, W. S., Kronmal, R. A., Bild, D. E., Shea, S., Liu, K., Watson, K. E., Folsom, A. R., Khera, A., Ayers, C., Mahabadi, A. A., Lehmann, N., Jöckel, K. H., Moebus, S., Carr, J. J., Erbel, R., & Burke, G. L. (2015). 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) with Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). Journal of the American College of Cardiology, 66(15), 1643-1653. https://doi.org/10.1016/j.jacc.2015.08.035