title: Assessing Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Categorization Between Coronary Artery Calcium Score and the American College of Cardiology/American Heart Association Cardiovascular Prevention Guidelines and the Potential Impact on Treatment Recommendations.
abstract: The 2013 American College of Cardiology/American Heart Association cardiovascular prevention guidelines use a new pooled cohort equation (PCE) to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events which form the basis of treatment recommendations. Coronary artery calcium score (CACS) has been proposed as a means to assess atherosclerotic risk. We sought to study the level of agreement in predicted ASCVD risk by CACS and PCE-calculated models and the potential impact on therapy of additional CACS testing. We studied 687 treatment naive, consecutive patients (mean age 53.5 years, 72% men) who had a CACS study at our institution. Clinical and imaging data were recorded. ASCVD risk was calculated using the published PCE-based algorithm. CACS-based risk was categorized by previously published recommendations. Risk stratification comparisons were made and level of agreement calculated. In the cohort, mean ASCVD PCE-calculated risk was 5.3 ± 5.2% and mean CACS was 80 ± 302 Agatston units (AU). Of the intermediate PCE-calculated risk (5% to <7.5%) cohort, 85% had CACS <100 AU. Of the cohort categorized as reasonable to treat per the ASCVD prevention guidelines, 40% had a CACS of 0 AU and an additional 44% had CACS >0 but <100 AU. The level of agreement between the new PCE model of ASCVD risk and demonstrable coronary artery calcium is low. CACS testing may be most beneficial in those with an intermediate risk of ASCVD (PCE-calculated risk of 5% to <7.5%) where, in approximately half of patients, CACS testing significantly refined risk assessment primarily into a very low-risk category.
authors.affiliation: Division of Cardiology, American University of Beirut, Beirut, Lebanon.
authors.forename: Hussain
authors.initials: H
authors.lastname: Isma'eel
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Min
authors.affiliation: Department of Vascular Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Laila
authors.initials: L
authors.lastname: Al-Shaar
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sandra
authors.initials: S
authors.lastname: Halliburton
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Gentry
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian
authors.initials: B
authors.lastname: Griffin
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: pheland@ccf.org.
authors.forename: Dermot
authors.initials: D
authors.lastname: Phelan
mesh_terms: D000328:Adult; D000368:Aged; D000572:American Heart Association; D050197:Atherosclerosis / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D002118:Calcium / Q000378:metabolism*; D002309:Cardiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D061330:Multidetector Computed Tomography / Q000379:methods*; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002118:Calcium