title: Providing Evidence for Subclinical CVD in Risk Assessment.
abstract: When the MESA (Multi-Ethnic Study of Atherosclerosis) began, the Framingham risk score was the preferred tool for 10-year global coronary heart disease risk assessment; however, the Framingham risk score had limitations including derivation in a homogenous population lacking racial and ethnic diversity and exclusive reliance on traditional risk factors without consideration of most subclinical disease measures. MESA was designed to study the prognostic value of subclinical atherosclerosis and other risk markers in a multiethnic population. In a series of landmark publications, MESA demonstrated that measures of subclinical cardiovascular disease add significant prognostic value to the traditional Framingham risk variables. In head-to-head studies comparing these markers, MESA established that the coronary artery calcium score may be the single best predictor of coronary heart disease risk. Results from MESA have directly influenced recent prevention guidelines including the recommendations on risk assessment and cholesterol-lowering therapy. The MESA study has published its own risk score, which allows for the calculation of 10-year risk of coronary heart disease before and after knowledge of a coronary artery calcium score.
authors.affiliation: Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA. Electronic address: mblaha1@jhmi.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Department of Internal Medicine/Cardiology, Wake Forest University Health Sciences, Winston Salem, NC, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
authors.affiliation: Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Al Rifai
authors.affiliation: Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.affiliation: Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000150:complications; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D010817:Physician-Patient Relations; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers