title: 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study).
abstract: BACKGROUND
  Several studies have demonstrated the tremendous potential of using coronary artery calcium (CAC) in addition to traditional risk factors for coronary heart disease (CHD) risk prediction. However, to date, no risk score incorporating CAC has been developed.
  
  
  OBJECTIVE
  The goal of this study was to derive and validate a novel risk score to estimate 10-year CHD risk using CAC and traditional risk factors.
  
  
  METHODS
  Algorithm development was conducted in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective community-based cohort study of 6,814 participants age 45 to 84 years, who were free of clinical heart disease at baseline and followed for 10 years. MESA is sex balanced and included 39% non-Hispanic whites, 12% Chinese Americans, 28% African Americans, and 22% Hispanic Americans. External validation was conducted in the HNR (Heinz Nixdorf Recall Study) and the DHS (Dallas Heart Study).
  
  
  RESULTS
  Inclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 vs. 0.75; p < 0.0001). External validation in both the HNR and DHS studies provided evidence of very good discrimination and calibration. Harrell's C-statistic was 0.779 in HNR and 0.816 in DHS. Additionally, the difference in estimated 10-year risk between events and nonevents was approximately 8% to 9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within one-half of a percent of the observed event rate.
  
  
  CONCLUSIONS
  An accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. The MESA risk score, which is available online on the MESA web site for easy use, can be used to aid clinicians when communicating risk to patients and when determining risk-based treatment strategies.
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington. Electronic address: rmcclell@u.washington.edu.
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Neal W
authors.initials: NW
authors.lastname: Jorgensen
authors.affiliation: Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.affiliation: Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Bild
authors.affiliation: Departments of Medicine and Epidemiology, Columbia University, New York, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.affiliation: Department of Preventive Medicine, Northwestern University Medical School, Chicago, Illinois.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Division of Cardiology, UCLA School of Medicine, Los Angeles, California.
authors.forename: Karol E
authors.initials: KE
authors.lastname: Watson
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
authors.affiliation: Division of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Colby
authors.initials: C
authors.lastname: Ayers
authors.affiliation: University Clinic Essen, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Essen, Germany.
authors.forename: Amir-Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: Institute of Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, University of Duisburg, Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Institute of Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, University of Duisburg, Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Institute of Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, University of Duisburg, Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Department of Radiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: University Clinic Essen, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000208:ethnology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000208:ethnology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
keywords: atherosclerosis; coronary disease; epidemiology; risk prediction