title: Computed tomography-derived cardiovascular risk markers, incident cardiovascular events, and all-cause mortality in nondiabetics: the Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  We assess the improvement in discrimination afforded by the addition of the computed tomography risk markers thoracic aorta calcium (TAC), aortic valve calcification (AVC), mitral annular calcification (MAC), pericardial adipose tissue volume (PAT), and liver attenuation (LA) to the Framingham risk score (FRS) + coronary artery calcium (CAC) for incident coronary heart disease (CHD) and incident cerebrovascular disease (CVD) in a multiethnic cohort.
  
  
  RESULTS
  A total of 5745 participants were enrolled, with 2710 at intermediate Framingham risk, 210 CVD events, and 155 CHD events). Over 9 years of follow up, 251 had adjudicated CHD, 346 had CVD events, and 321 died. The data were analysed using Cox proportional hazard, receiver operator curve (ROC), and net reclassification improvement (NRI) analyses. In the whole cohort and also when the analysis was restricted to only the intermediate-risk participants, CAC, TAC, AVC, and MAC were all significantly associated with incident CVD, incident CHD, and mortality, and CAC had the strongest association. When added to the FRS, CAC had the highest area under the curve (AUC) for the prediction of incident CVD and incident CHD; LA had the least. The addition of TAC, AVC, MAC, PAT, and LA to FRS + CAC all resulted in a significant reduction in AUC for incident CHD (0.712 vs. 0.646, 0.655, 0.652, 0.648, and 0.569; all p < 0.01, respectively) in participants with intermediate FRS. The addition of CAC to FRS resulted in an NRI of 0.547 for incident CHD in the intermediate-risk group. The NRI when TAC, AVC, MAC, PAT, and LA were added to FRS + CAC were 0.024, 0.026, 0.019, 0.012, and 0.012, respectively, for incident CHD in the intermediate-risk group. Similar results were obtained for incident CVD in the intermediate-risk group and also when the whole cohort was used instead of the intermediate FRS group.
  
  
  CONCLUSIONS
  The addition of CAC to the FRS provides superior discrimination especially in intermediate-risk individuals compared with the addition of TAC, AVC, MAC, PAT, or LA for incident CVD and incident CHD. Compared with FRS + CAC, the addition of TAC, AVC, MAC, PAT, or LA individually to FRS + CAC worsens the discrimination for incident CVD and incident CHD. These risk markers are unlikely to be useful for improving cardiovascular risk prediction.
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, USA jyeboah@wakehealth.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: J Jeffery
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Terry
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jingzhong
authors.initials: J
authors.lastname: Ding
authors.affiliation: Bronx-Lebanon Hospital Center, Bronx, NY, USA.
authors.forename: Irfan
authors.initials: I
authors.lastname: Zeb
authors.affiliation: National Institutes of Health, Bethesda, MD, USA.
authors.forename: Songtao
authors.initials: S
authors.lastname: Liu
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Post
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001027:Aortography / Q000379:methods*; D019540:Area Under Curve; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D016002:Discriminant Analysis; D005260:Female; D006304:Health Status; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000401:mortality
keywords: Cardiac CT-derived risk factors; cardiovascular events; coronary heart disease; risk prediction