title: Extensive carotid atherosclerosis and the diagnostic accuracy of coronary risk calculators.
abstract: Preventive therapy in primary care is guided by risk thresholds for future cardiovascular events. We aimed to assess whether the sensitivity of various risk calculators for the detection of subclinical carotid atherosclerosis (TPA80) could be improved by lowering risk thresholds in younger age groups. We compared sensitivity, specificity, and discriminatory performance of SCORE, SCORE-HDL, PROCAM, AGLA, FRAM and PCE coronary risk calculators to detect total plaque area > 80 mm2 (TPA80), a coronary risk equivalent, in age groups 40-55, 56-65, 66-75 from Germany (DE,N= 2942) and Switzerland (CH,N= 2202) during the years 2002 to 2016. All calculators showed good to moderate discriminatory performance to detect TPA80 with AUC ranging from 0.74 (CH-AGLA) to 0.87 (DE- SCORE), but the sensitivity of high risk risk thresholds varied widely from 39% for DE-FRAM-CVD to 5% for CH-AGLA. Lowering of the risk threshold increased sensitivity substantially at the expense of minor losses in specificity, but the sensitivity generally remained < 45% at the 90% specificity threshold. Current risk thresholds of American and European coronary risk calculators have a low sensitivity to detect TPA80 in younger individuals.
authors.affiliation: Vascular Risk Foundation, Olten, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Romanens
authors.affiliation: Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark.
authors.forename: Martin Bødtker
authors.initials: MB
authors.lastname: Mortensen
authors.affiliation: University Heart Center, Cardiology, University Hospital, Zurich, Switzerland.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sudano
authors.affiliation: European Centre of Pharmaceutical Medicine (ECPM), Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Szucs
authors.affiliation: BAD Gesundheitsvorsorge und Sicherheitstechnik GmbH, Bonn, Germany.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Adams
keywords: Atherosclerosis; Carotid plaque; Risk-prediction; Statin-indication