Combined Framingham Risk Score and Coronary Artery Calcium Score Predict Subclinical Coronary Plaque Assessed by Coronary Computed Tomography Angiogram in Asymptomatic Taiwanese Population.
BACKGROUND
We sought to determine the predictive value of the combined traditional Framingham risk score (FRS) and coronary artery calcium score (CACS) for subclinical coronary plaque detected by computed tomography coronary angiogram (CTCA) in asymptomatic subjects.


METHODS
We evaluated 167 asymptomatic Taiwanese subjects (mean age, 57 ± 11.2 years), who underwent CTCA as part of a health evaluation. We examined the associations between FRS, CACS, serum biomarkers, and coronary plaque assessed by CTCA.


RESULTS
Out of 167 subjects in the study, 95 had coronary artery atheroma. Of those possible predictors for coronary atherosclerosis, both FRS and CACS were independent predictors for the presence of coronary plaque [relative risk (RR): 1.29, 95% confidence interval (CI): 1.07-1.54, p = 0.006 and RR: 1.42, 95% CI: 1.16-1.75, p = 0.001, respectively]. Receiver operating characteristics curve analysis revealed that CACS and FRS were indicators of the presence of coronary plaque. The area under the curve for FRS and CACS was 0.729 and 0.889, respectively (p < 0.001). Furthermore, the area under the curve for combination of FRS and CACS was 0.936 (95% CI: 0.887-0.969, p < 0.001), and this combination provided a better diagnostic advantage than either FRS or CACS alone (p < 0.001 and p = 0.012 by C-statistic, respectively).


CONCLUSIONS
In asymptomatic Taiwanese subjects with low to intermediate cardiovascular risk, both FRS and CACS were independently related to subclinical atherosclerosis. A combined FRS and CACS evaluation improved the efficacy of prediction for atherosclerotic plaque burden.


BACKGROUND
Atherosclerosis; Computed coronary tomography angiogram; Coronary artery calcium score; Framingham risk score; Subclinical coronary plaque.
Division of Cardiology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ; Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, New York, United States of America.
Jong-Shiuan
JS
Yeh
Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan;
Yung-Ta
YT
Kao
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ; Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan;
Feng-Yen
FY
Lin
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ; Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan;
Chun-Ming
CM
Shih
Division of Cardiovascular Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan;
Nai-Wen
NW
Tsao
Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan;
Chao-Shun
CS
Chan
Division of Cardiology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;
Ming-Hsiung
MH
Hsieh
Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; ; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;
Kou-Gi
KG
Shyu
Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan;
Jaw-Wen
JW
Chen
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ; Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan;
Nen-Chung
NC
Chang
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ; Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan;
Chun-Yao
CY
Huang