Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden

Hélder Alexandre Correia Dores*, Pedro de Araújo Gonçalves, António Miguel Ferreira , Maria Salomé Carvalho, Pedro Jerónimo Sousa, Nuno Cardim, Hugo Marques, Francisco Pereira Machado

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

To evaluate the performance of traditional cardiovascular (CV) risk factors in identifying a higher than expected coronary atherosclerotic burden.We assessed 2069 patients undergoing coronary CT angiography, with assessment of calcium score (CS), for suspected coronary artery disease. A higher than expected atherosclerotic burden was defined as CS >75th percentile (CS >P75) according to age and gender-adjusted monograms. The ability of traditional CV risk factors to predict a CS >P75 was assessed in a customized logistic regression model ("Clinical Score") and by the calculation of SCORE (Systemic Coronary Risk Evaluation). The population attributable risk (PAR) of risk factors for CS >P75 was calculated.The median CS was 3.0 (IQR 0.0-98.0); 362 patients had CS >P75. The median SCORE was 3.0 (IQR 1.0-4.0). With the exception of hypertension, all traditional CV risk factors were independent predictors of CS >P75: diabetes, dyslipidemia, smoking and family history (OR 1.3-2.2, p≤0.026). The areas under the ROC curves for CS >P75 were 0.64 for the Clinical Score (95% CI 0.61-0.67, pP75 were in the two lower quartiles of the Clinical Score. Altogether, the traditional risk factors explain 56% of the prevalence of CS >P75 (adjusted PAR 0.56). Despite the association of CV risk factors with a higher than expected atherosclerotic burden, they appear to explain only half of its prevalence. Even when integrated in scores, the predictive power of these risk factors was modest, exposing the limitations of risk stratification based solely on demographic and clinical risk factors.
Translated title of the contributionDesempenho dos fatores de risco clássicos na identificação de uma carga aterosclerótica coronária superior ao esperado
Original languageEnglish
Article number617
Pages (from-to)247-253
Number of pages7
JournalRevista Portuguesa de Cardiologia
Volume34
Issue number4
DOIs
Publication statusPublished - 1 Apr 2015
Externally publishedYes

Keywords

  • Atherosclerotic burden
  • Attributable risk
  • Calcium score
  • CT angiography
  • Risk factor

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