TY - JOUR
T1 - Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden
AU - Dores, Hélder Alexandre Correia
AU - Gonçalves, Pedro de Araújo
AU - Ferreira , António Miguel
AU - Carvalho, Maria Salomé
AU - Sousa, Pedro Jerónimo
AU - Cardim, Nuno
AU - Marques, Hugo
AU - Machado , Francisco Pereira
PY - 2015/4/1
Y1 - 2015/4/1
N2 - 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.
AB - 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.
KW - Atherosclerotic burden
KW - Attributable risk
KW - Calcium score
KW - CT angiography
KW - Risk factor
KW - Carga aterosclerótica
KW - Fator de risco
KW - Score de cálcio
KW - AngioTC
UR - https://www.scopus.com/record/display.uri?eid=2-s2.0-84928207800&origin=resultslist&sort=plf-f&src=s&st1=10.1016%2fj.repc.2014.08.030&sid=30f7262d576c6ef64ffa884e2809dd08&sot=b&sdt=b&sl=31&s=DOI%2810.1016%2fj.repc.2014.08.030%29&relpos=0&citeCnt=7&searchTerm=&featureToggles=FEATURE_NEW_DOC_DETAILS_EXPORT:1
U2 - 10.1016/j.repc.2014.08.030
DO - 10.1016/j.repc.2014.08.030
M3 - Article
C2 - 25843312
VL - 34
SP - 247
EP - 253
JO - Revista Portuguesa de Cardiologia
JF - Revista Portuguesa de Cardiologia
SN - 0870-2551
IS - 4
M1 - 617
ER -