title: Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden.
abstract: OBJECTIVE
  To evaluate the performance of traditional cardiovascular (CV) risk factors in identifying a higher than expected coronary atherosclerotic burden.
  
  
  METHODS
  We assessed 2069 patients undergoing coronary CT angiography, with assessment of calcium score (CS), for suspected coronary artery disease. A higher than expected atherosclerotic burden was defined as CS >75th percentile (CS >P75) according to age and gender-adjusted monograms. The ability of traditional CV risk factors to predict a CS >P75 was assessed in a customized logistic regression model ("Clinical Score") and by the calculation of SCORE (Systemic Coronary Risk Evaluation). The population attributable risk (PAR) of risk factors for CS >P75 was calculated.
  
  
  RESULTS
  The median CS was 3.0 (IQR 0.0-98.0); 362 patients had CS >P75. The median SCORE was 3.0 (IQR 1.0-4.0). With the exception of hypertension, all traditional CV risk factors were independent predictors of CS >P75: diabetes, dyslipidemia, smoking and family history (OR 1.3-2.2, p≤0.026). The areas under the ROC curves for CS >P75 were 0.64 for the Clinical Score (95% CI 0.61-0.67, p<0.001) and 0.53 for SCORE (95% CI 0.50-0.56, p=0.088). About a quarter of patients with CS >P75 were in the two lower quartiles of the Clinical Score. Altogether, the traditional risk factors explain 56% of the prevalence of CS >P75 (adjusted PAR 0.56).
  
  
  CONCLUSIONS
  Despite the association of CV risk factors with a higher than expected atherosclerotic burden, they appear to explain only half of its prevalence. Even when integrated in scores, the predictive power of these risk factors was modest, exposing the limitations of risk stratification based solely on demographic and clinical risk factors.
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Centro Cardiovascular, Hospital da Luz, Luz-Saúde, Lisboa, Portugal; Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal. Electronic address: heldores@hotmail.com.
authors.forename: Hélder
authors.initials: H
authors.lastname: Dores
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Centro Cardiovascular, Hospital da Luz, Luz-Saúde, Lisboa, Portugal; Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: de Araújo Gonçalves
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Centro de Imagiologia, Hospital da Luz, Luz-Saúde, Lisboa, Portugal.
authors.forename: António Miguel
authors.initials: AM
authors.lastname: Ferreira
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
authors.forename: Maria Salomé
authors.initials: MS
authors.lastname: Carvalho
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Centro Cardiovascular, Hospital da Luz, Luz-Saúde, Lisboa, Portugal.
authors.forename: Pedro Jerónimo
authors.initials: PJ
authors.lastname: Sousa
authors.affiliation: Centro Cardiovascular, Hospital da Luz, Luz-Saúde, Lisboa, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Cardim
authors.affiliation: Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.affiliation: Centro Cardiovascular, Hospital da Luz, Luz-Saúde, Lisboa, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pereira Machado
mesh_terms: D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
keywords: AngioTC; Atherosclerotic burden; Attributable risk; CT angiography; Calcium score; Carga Aterosclerótica; Fator de risco; Risk factor; Score de cálcio