Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score
BackgroundCoronary artery calcium (CAC) scanning is a valuable additional tool for calculating the risk of cardiovascular (CV) events. We aimed to determine if a CAC score could improve performance of a Thai CV risk score in prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk f...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1264640/full |
| _version_ | 1797640115317637120 |
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| author | Noppanat Tiansuwan Thinnakrit Sasiprapha Sutipong Jongjirasiri Nattawut Unwanatham Ammarin Thakkinstian Jiraporn Laothamatas Thosaphol Limpijankit |
| author_facet | Noppanat Tiansuwan Thinnakrit Sasiprapha Sutipong Jongjirasiri Nattawut Unwanatham Ammarin Thakkinstian Jiraporn Laothamatas Thosaphol Limpijankit |
| author_sort | Noppanat Tiansuwan |
| collection | DOAJ |
| description | BackgroundCoronary artery calcium (CAC) scanning is a valuable additional tool for calculating the risk of cardiovascular (CV) events. We aimed to determine if a CAC score could improve performance of a Thai CV risk score in prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk for asymptomatic patients with CV risk factors.MethodsThis was a retrospective cohort study that enrolled asymptomatic patients with CV risk factors who underwent CAC scans between 2005 and 2013. The patients were classified as low-, intermediate-, or high-risk (<10%, 10%–<20%, and ≥20%, respectively) of having ASCVD within 10-years based on a Thai CV risk score. In each patient, CAC score was considered as a categorical variable (0, 1–99, and ≥100) and natural-log variable to assess the risk of developing CV events (CV death, non-fatal MI, or non-fatal stroke). The C statistic and the net reclassification improvement (NRI) index were applied to assess whether CAC improved ASCVD risk prediction.ResultsA total of 6,964 patients were analyzed (mean age: 59.0 ± 8.4 years; 63.3% women). The majority of patients were classified as low- or intermediate-risk (75.3% and 20.5%, respectively), whereas only 4.2% were classified as high-risk. Nearly half (49.7%) of patients had a CAC score of zero (no calcifications detected), while 32.0% had scores of 1–99, and 18.3% of ≥100. In the low- and intermediate-risk groups, patients with a CAC ≥100 experienced higher rates of CV events, with hazard ratios (95% CI) of 1.95 (1.35, 2.81) and 3.04 (2.26, 4.10), respectively. Incorporation of ln(CAC + 1) into their Thai CV risk scores improved the C statistic from 0.703 (0.68, 0.72) to 0.716 (0.69, 0.74), and resulted in an NRI index of 0.06 (0.02, 0.10). To enhance the performance of the Thai CV risk score, a revision of the CV risk model was performed, incorporating ln(CAC + 1), which further increased the C statistic to 0.771 (0.755, 0.788).ConclusionThe addition of CAC to traditional risk factors improved CV risk stratification and ASCVD prediction. Whether this adjustment leads to a reduction in CV events and is cost-effective will require further assessment. |
| first_indexed | 2024-03-11T13:27:17Z |
| format | Article |
| id | doaj.art-32bb143bd6214953912cc1cc74d6e96b |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-11T13:27:17Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-32bb143bd6214953912cc1cc74d6e96b2023-11-03T05:54:43ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-11-011010.3389/fcvm.2023.12646401264640Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk scoreNoppanat Tiansuwan0Thinnakrit Sasiprapha1Sutipong Jongjirasiri2Nattawut Unwanatham3Ammarin Thakkinstian4Jiraporn Laothamatas5Thosaphol Limpijankit6Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, ThailandDivision of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, ThailandDepartment of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, ThailandDepartment of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, ThailandDepartment of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, ThailandFaculty of Heath Science Technology, Chulabhorn Royal Academy, Bangkok, ThailandDivision of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, ThailandBackgroundCoronary artery calcium (CAC) scanning is a valuable additional tool for calculating the risk of cardiovascular (CV) events. We aimed to determine if a CAC score could improve performance of a Thai CV risk score in prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk for asymptomatic patients with CV risk factors.MethodsThis was a retrospective cohort study that enrolled asymptomatic patients with CV risk factors who underwent CAC scans between 2005 and 2013. The patients were classified as low-, intermediate-, or high-risk (<10%, 10%–<20%, and ≥20%, respectively) of having ASCVD within 10-years based on a Thai CV risk score. In each patient, CAC score was considered as a categorical variable (0, 1–99, and ≥100) and natural-log variable to assess the risk of developing CV events (CV death, non-fatal MI, or non-fatal stroke). The C statistic and the net reclassification improvement (NRI) index were applied to assess whether CAC improved ASCVD risk prediction.ResultsA total of 6,964 patients were analyzed (mean age: 59.0 ± 8.4 years; 63.3% women). The majority of patients were classified as low- or intermediate-risk (75.3% and 20.5%, respectively), whereas only 4.2% were classified as high-risk. Nearly half (49.7%) of patients had a CAC score of zero (no calcifications detected), while 32.0% had scores of 1–99, and 18.3% of ≥100. In the low- and intermediate-risk groups, patients with a CAC ≥100 experienced higher rates of CV events, with hazard ratios (95% CI) of 1.95 (1.35, 2.81) and 3.04 (2.26, 4.10), respectively. Incorporation of ln(CAC + 1) into their Thai CV risk scores improved the C statistic from 0.703 (0.68, 0.72) to 0.716 (0.69, 0.74), and resulted in an NRI index of 0.06 (0.02, 0.10). To enhance the performance of the Thai CV risk score, a revision of the CV risk model was performed, incorporating ln(CAC + 1), which further increased the C statistic to 0.771 (0.755, 0.788).ConclusionThe addition of CAC to traditional risk factors improved CV risk stratification and ASCVD prediction. Whether this adjustment leads to a reduction in CV events and is cost-effective will require further assessment.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1264640/fullcoronary artery calcium (CAC)coronary artery calcium score (CACS)atherosclerotic cardiovascular disease (ASCVD) risk predictioncardiovascular (CV) risk stratificationThai CV risk score |
| spellingShingle | Noppanat Tiansuwan Thinnakrit Sasiprapha Sutipong Jongjirasiri Nattawut Unwanatham Ammarin Thakkinstian Jiraporn Laothamatas Thosaphol Limpijankit Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score Frontiers in Cardiovascular Medicine coronary artery calcium (CAC) coronary artery calcium score (CACS) atherosclerotic cardiovascular disease (ASCVD) risk prediction cardiovascular (CV) risk stratification Thai CV risk score |
| title | Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score |
| title_full | Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score |
| title_fullStr | Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score |
| title_full_unstemmed | Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score |
| title_short | Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score |
| title_sort | utility of coronary artery calcium in refining 10 year ascvd risk prediction using a thai cv risk score |
| topic | coronary artery calcium (CAC) coronary artery calcium score (CACS) atherosclerotic cardiovascular disease (ASCVD) risk prediction cardiovascular (CV) risk stratification Thai CV risk score |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1264640/full |
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