03863nas a2200397 4500008004100000022001400041245014600055210006900201260001600270520264500286100001902931700003002950700001802980700002002998700001903018700001803037700002203055700002003077700001903097700001903116700001803135700001903153700002003172700001803192700002403210700002303234700002503257700002103282700002003303700002403323700002103347700001503368700002403383700002203407856003603429 2017 eng d a2380-659100aAssociation of Coronary Artery Calcium Score vs Age With Cardiovascular Risk in Older Adults: An Analysis of Pooled Population-Based Studies.0 aAssociation of Coronary Artery Calcium Score vs Age With Cardiov c2017 Jul 263 a

Importance: Besides age, other discriminators of atherosclerotic cardiovascular disease (ASCVD) risk are needed in older adults.

Objectives: To examine the predictive ability of coronary artery calcium (CAC) score vs age for incident ASCVD and how risk prediction changes by adding CAC score and removing only age from prediction models.

Design, Setting, and Participants: We conducted an analysis of pooled US population-based studies, including the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Results were compared with 2 European cohorts, the Rotterdam Study and the Heinz Nixdorf Recall Study. Participants underwent CAC scoring between 1998 and 2006 using cardiac computed tomography. The participants included adults older than 60 years without known ASCVD at baseline.

Exposures: Coronary artery calcium scores.

Main Outcomes and Measures: Incident ASCVD events including coronary heart disease (CHD) and stroke.

Results: The study included 4778 participants from 3 US cohorts, with a mean age of 70.1 years; 2582 (54.0%) were women, and 2431 (50.9%) were nonwhite. Over 11 years of follow-up (44 152 person-years), 405 CHD and 228 stroke events occurred. Coronary artery calcium score (vs age) had a greater association with incident CHD (C statistic, 0.733 vs 0.690; C statistics difference, 0.043; 95% CI of difference, 0.009-0.075) and modestly improved prediction of incident stroke (C statistic, 0.695 vs 0.670; C statistics difference, 0.025; 95% CI of difference, -0.015 to 0.064). Adding CAC score to models including traditional cardiovascular risk factors, with only age being removed, provided improved discrimination for incident CHD (C statistic, 0.735 vs 0.703; C statistics difference, 0.032; 95% CI of difference, 0.002-0.062) but not for stroke. Coronary artery calcium score was more likely than age to provide higher category-free net reclassification improvement among participants who experienced an ASCVD event (0.390; 95% CI, 0.312-0.467 vs 0.08; 95% CI -0.001 to 0.181) and to result in more accurate reclassification of risk for ASCVD events among these individuals. The findings were similar in the 2 European cohorts (n = 4990).

Conclusions and Relevance: Coronary artery calcium may be an alternative marker besides age to better discriminate between lower and higher CHD risk in older adults. Whether CAC score can assist in guiding the decision to initiate statin treatment for primary prevention in older adults requires further investigation.

1 aYano, Yuichiro1 aO'Donnell, Christopher, J1 aKuller, Lewis1 aKavousi, Maryam1 aErbel, Raimund1 aNing, Hongyan1 aD'Agostino, Ralph1 aNewman, Anne, B1 aNasir, Khurram1 aHofman, Albert1 aLehmann, Nils1 aDhana, Klodian1 aBlankstein, Ron1 aHoffmann, Udo1 aMöhlenkamp, Stefan1 aMassaro, Joseph, M1 aMahabadi, Amir-Abbas1 aLima, João, A C1 aIkram, Arfan, M1 aJöckel, Karl-Heinz1 aFranco, Oscar, H1 aLiu, Kiang1 aLloyd-Jones, Donald1 aGreenland, Philip uhttps://chs-nhlbi.org/node/7442