title: Coronary artery calcification score as tool for risk assessment among families with premature coronary artery disease.
abstract: BACKGROUND
  There is discussion about incorporating a family history (FamHis) of premature coronary artery disease (CAD) in risk score algorithms. However, FamHis provides information on individual risk. Coronary artery calcification score (CACS) is a metric of atherosclerosis that may determine the individual risk within families at high risk of premature CAD.
  
  
  METHODS
  In asymptomatic individuals (n = 704), we assessed the association between FamHis of CAD and elevated CACS. To assess the predictive value of CACS in individuals with a FamHis of CAD, we performed a post-hoc analysis on the St. Francis Heart Study (n = 834). We assessed, in a case control design, the risk of future CAD in individuals with a FamHis of CAD and either CACS >80th percentile or no CACS at all.
  
  
  RESULTS
  Individuals with a FamHis for CAD had an increased risk for elevated CACS (adjusted odds ratio (OR) 2.23 (95% CI 1.48-3.36); p < 0.05), compared to those without a FamHis. In the prospective study (3.5 years follow-up), the event rate equally low in those with a positive FamHis and a negative FamHis (0% vs. 1%), if they had a CAC of 0. However, in those with CACS >80(th) percentile, a FamHis of CAD doubled the CAD event rate (positive FamHis 12.5% vs. negative FamHis 6.8%; adjusted HR 2.08 (95% CI 1.09-3.87; p < 0.05).
  
  
  CONCLUSIONS
  CAC scoring leads to risk discrimination among those with a positive FamHis for premature CAD. These results support testing CAC score in asymptomatic individuals with a positive FamHis to identify a high risk population.
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ties A
authors.initials: TA
authors.lastname: Mulders
authors.affiliation: Healthy Heart Prevention Clinic, Providence Heart and Lung Institute, St. Paul Hospital, Vancouver, British Columbia, Canada.
authors.forename: Catalin
authors.initials: C
authors.lastname: Taraboanta
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Lotte C
authors.initials: LC
authors.lastname: Franken
authors.affiliation: Prescan, Hengelo, The Netherlands.
authors.forename: Eddy
authors.initials: E
authors.lastname: van Heel
authors.affiliation: Prescan, Hengelo, The Netherlands.
authors.forename: Gunter
authors.initials: G
authors.lastname: Klass
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Forster
authors.affiliation: Tiara Pharmaceuticals, Los Altos, CA, USA.
authors.forename: Yadon
authors.initials: Y
authors.lastname: Arad
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.affiliation: Healthy Heart Prevention Clinic, Providence Heart and Lung Institute, St. Paul Hospital, Vancouver, British Columbia, Canada.
authors.forename: Jiri
authors.initials: J
authors.lastname: Fröhlich
authors.affiliation: Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Guerci
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Erik S G
authors.initials: ES
authors.lastname: Stroes
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: s.j.pinto@amc.nl.
authors.forename: Sara-Joan
authors.initials: SJ
authors.lastname: Pinto-Sietsma
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D003331:Coronary Vessels; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology
keywords: CAC score; Family history of premature CAD; Risk assessment