title: Calcium scores in the risk assessment of an asymptomatic population: implications for airline pilots.
abstract: BACKGROUND
  This study evaluated whether coronary artery calcium score (CACS) improved cardiovascular disease risk prediction when compared to the New Zealand Cardiovascular Risk Charts (NZ-CRC), and describes the potential utilization of CACS in cardiovascular disease (CVD) risk assessment of pilots.
  
  
  METHODS
  A cross-sectional study was performed among asymptomatic patients who underwent coronary computed tomography angiography at Pacific Radiology Wellington, New Zealand, between August 2007 and July 2012 and had their CACS and CVD risk score calculated. Receiver-operating characteristics (ROC) analyses were used to measure the accuracy of the NZ-CRC and CACS. Reclassification analyses were performed to examine the net reclassification improvement (NRI) of CACS when compared to NZ-CRC.
  
  
  RESULTS
  Over a 5-yr study period, 237 male asymptomatic patients with ages ranging from 30 to 69 yr with a mean (SD) of 53.24 (8.18) yr, were included. The area under the ROC curves (AUC) (95% CI) for CACS and NZ-CRC were 0.88 (0.83-0.93) and 0.66 (0.59-0.73), respectively. The NRI (95% CI) of the calcium scores was 0.39 (0.17-0.62). CACS should be assessed in pilots with 5-yr CVD risk scores of 5-10% and 10-15%.
  
  
  CONCLUSIONS
  CACS has a better accuracy than the NZ-CRC and reclassified a considerable proportion of asymptomatic patients into correct cardiovascular risk categories. An approach on how the CACS should be employed in the cardiovascular risk assessment of airline pilots is noted in this paper.
authors.affiliation: Occupational Health Department, Udayana University, Bali, Indonesia.
authors.forename: I Made Ady
authors.initials: IM
authors.lastname: Wirawan
authors.forename: Rodney
authors.initials: R
authors.lastname: Wu
authors.forename: Malcolm
authors.initials: M
authors.lastname: Abernethy
authors.forename: Sarah
authors.initials: S
authors.lastname: Aldington
authors.forename: Peter D
authors.initials: PD
authors.lastname: Larsen
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D000368:Aged; D001359:Aviation; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging*; D014938:Work Capacity Evaluation