Cardiovascular risk scores in the prediction of subclinical atherosclerosis in young adults: evidence from the cardiovascular risk in a young Finns study.
OBJECTIVE
To study the utility of risk scores in the prediction of subclinical atherosclerosis in young adults.


RESULTS
Participants were 2204 healthy Finnish adults aged 24-39 years in 2001 from a population-based follow-up study Cardiovascular Risk in Young Finns. We examined the performance of the Framingham, Reynolds, Systematic Coronary Risk Evaluation (SCORE), PROCAM, and Finrisk cardiovascular risk scores to predict subclinical atherosclerosis, that is carotid artery intima-media thickness (IMT) and plaque, carotid artery distensibility (CDist), and brachial artery flow-mediated dilatation (FMD) 6 years later. In a 6-year prediction of high IMT (highest decile or plaque), areas under the receiver operating characteristic curves (AUC) for baseline Finrisk (0.733), SCORE (0.726), PROCAM (0.712), and Reynolds (0.729) risk scores were similar as for Framingham risk score (0.728, P always ≥0.15). All risk scores had a similar discrimination in predicting low CDist (lowest decile) (0.652, 0.642, 0.639, 0.658, 0.652 respectively, P always ≥0.41). In the prediction of low FMD (lowest decile), Finrisk, PROCAM, Reynolds, and Framingham scores had similar AUCs (0.578, 0.594, 0.582, 0.568, P always ≥0.08) and SCORE discriminated slightly better (AUC=0.596, P<0.05). The prediction of subclinical outcomes was consistent when estimated from other statistical measures of discrimination, reclassification, and calibration.


CONCLUSIONS
Cardiovascular disease risk scores had equal value in predicting subclinical atherosclerosis measured by IMT and CDist in young adults. SCORE was more accurate in predicting low FMD than Framingham risk score.
Raiko
Juho R H
JR
Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital dFinnish Institute of Occupational Health, Helsinki, Finland. juho.raiko@utu.fi
Magnussen
Costan G
CG
Kivimäki
Mika
M
Taittonen
Leena
L
Laitinen
Tomi
T
Kähönen
Mika
M
Hutri-Kähönen
Nina
N
Jula
Antti
A
Loo
Britt-Marie
BM
Thomson
Russell J
RJ
Lehtimäki
Terho
T
Viikari
Jorma S A
JS
Raitakari
Olli T
OT
Juonala
Markus
M
D000328:Adult; D000367:Age Factors; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology; D004548:Elasticity; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014664:Vasodilation; D055815:Young Adult