title: Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population.
abstract: OBJECTIVE
  To compare the predictive value of coronary artery calcification (CAC), carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) in a primary prevention cohort depending on risk factor profile to determine which of the three markers improves cardiovascular (CV) risk discrimination best in which risk group.
  
  
  RESULTS
  We quantified CAC, CIMT, and ABI in 3108 subjects (mean age 59.2 ± 7.7, 47.1% male) without prevalent CV diseases from the population-based Heinz Nixdorf Recall study. Associations with incident major CV events (coronary event, stroke, CV death; n = 223) were assessed during a follow-up period of 10.3 ± 2.8 years with Cox proportional regressions in the total cohort and stratified by Framingham risk score (FRS) groups. Discrimination ability was evaluated with Harrell's C. All three markers were associated with CV events (hazard ratio [95% confidence interval (CI)]: CAC: 1.31 (1.23-1.39) per 1-unit increase in log(CAC + 1) vs. CIMT: 1.27 (1.13-1.43) per 1 SD vs. ABI: 1.30 (1.14-1.49) per 1 SD, in FRS adjusted models). Considering reclassification, CAC lead to highest reclassification in the total cohort, while also for CIMT and ABI significant improvement in net-reclassification was observed [NRI (95% CI): CAC: 0.55 (0.42-0.69); CIMT: 0.32 (0.19-0.45); ABI: 0.19 (0.10-0.28)].
  
  
  CONCLUSIONS
  Coronary artery calcification provides the best discrimination of risk compared with CIMT and ABI, particularly in the intermediate risk group, whereas CIMT may be an alternative measure for reassurance in the low risk group.
authors.affiliation: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.|Clinical Epidemiology, Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
authors.forename: Marie Henrike
authors.initials: MH
authors.lastname: Geisel
authors.affiliation: Medizinische Klinik II, St. Vincenz-Krankenhaus Datteln, Rottstraße 11, 45711 Datteln, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Gurlittstr. 55/II, 40223 Düsseldorf, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Hennig
authors.affiliation: Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Gurlittstr. 55/II, 40223 Düsseldorf, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hoffmann
authors.affiliation: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Department of Cardiology, Krankenhaus Bethanien, Bethanienstraße 21, 47441 Moers, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Möhlenkamp
authors.affiliation: HELIOS Klinikum Krefeld GmbH, Klinik für Gefäßmedizin, Lutherplatz 40, 47805 Krefeld, Germany.
authors.forename: Knut
authors.initials: K
authors.lastname: Kröger
authors.affiliation: Cardiovascular Center, St. Josef Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany.
authors.forename: Kaffer
authors.initials: K
authors.lastname: Kara
authors.affiliation: Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Müller
authors.affiliation: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Clinical Epidemiology, Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Scherag
authors.affiliation: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Mahabadi
mesh_terms: D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D061205:Vascular Calcification / Q000175:diagnosis* / Q000453:epidemiology
keywords: ABI; CAC; CIMT; Epidemiology; Primary prevention; Risk discrimination