title: Framingham score and LV mass predict events in young adults: CARDIA study.
abstract: BACKGROUND
  Framingham risk score (FRS) underestimates risk in young adults. Left ventricular mass (LVM) relates to cardiovascular disease (CVD), with unclear value in youth. In a young biracial cohort, we investigate how FRS predicts CVD over 20 years and the incremental value of LVM. We also explore the predictive ability of different cut-points for hypertrophy.
  
  
  METHODS
  We assessed FRS and echocardiography-derived LVM (indexed by body surface area or height2.7) from 3980 African-American and white Coronary Artery Risk Development in Young Adults (CARDIA) participants (1990-1991); and followed over 20 years for a combined endpoint: cardiovascular death; nonfatal myocardial infarction, heart failure, cerebrovascular disease, and peripheral artery disease. We assessed the predictive ability of FRS for CVD and also calibration, discrimination, and net reclassification improvement for adding LVM to FRS.
  
  
  RESULTS
  Mean age was 30±4 years, 46% males, and 52% white. Event incidence (n=118) across FRS groups was, respectively, 1.3%, 5.4%, and 23.1% (p<0.001); and was 1.4%, 1.3%, 3.7%, and 5.4% (p<0.001) across quartiles of LVM (cut-points 117 g, 144 g, and 176 g). LVM predicted CVD independently of FRS, with the best performance in normal weight participants. Adding LVM to FRS modestly increased discrimination and had a statistically significant reclassification. The 85th percentile (≥116 g/m2 for men; ≥96 g/m2 for women) showed event prediction more robust than currently recommended cut-points for hypertrophy.
  
  
  CONCLUSIONS
  In a biracial cohort of young adults, FRS and LVM are helpful independent predictors of CVD. LVM can modestly improve discrimination and reclassify participants beyond FRS. Currently recommended cut-points for hypertrophy may be too high for young adults.
authors: Johns Hopkins University, Baltimore, MD, USA; Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil.
authors: Anderson C
authors: AC
authors: Armstrong
authors: University of Minnesota, Minneapolis, MN, USA.
authors: David R
authors: DR
authors: Jacobs
authors: Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE, USA.
authors: Samuel S
authors: SS
authors: Gidding
authors: Northwestern University, Chicago, IL, USA.
authors: Laura A
authors: LA
authors: Colangelo
authors: Johns Hopkins University, Baltimore, MD, USA.
authors: Ola
authors: O
authors: Gjesdal
authors: University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Cora E
authors: CE
authors: Lewis
authors: University of California at San Francisco, San Francisco, CA, USA.
authors: Kirsten
authors: K
authors: Bibbins-Domingo
authors: Kaiser Permanente Division of Research, Oakland, CA, USA.
authors: Stephen
authors: S
authors: Sidney
authors: University of Minnesota, Minneapolis, MN, USA.
authors: Pamela J
authors: PJ
authors: Schreiner
authors: Florida International University, Miami, FL, USA.
authors: O D
authors: OD
authors: Williams
authors: Colorado School of Public Health, Aurora, CO, USA.
authors: David C
authors: DC
authors: Goff
authors: Northwestern University, Chicago, IL, USA.
authors: Kiang
authors: K
authors: Liu
authors: Johns Hopkins University, Baltimore, MD, USA. Electronic address: jlima@jhmi.edu.
authors: Joao A C
authors: JA
authors: Lima
mesh_terms: D000328:Adult; D000465:Algorithms; D044383:Black People; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000208:ethnology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
keywords: Cardiovascular risk; Echocardiography; Left ventricular hypertrophy; Young adults