The Association of Framingham and Reynolds Risk Scores With Incidence and Progression of Coronary Artery Calcification in MESA (Multi-Ethnic Study of Atherosclerosis)

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• 作者：Andrew P.  ; DeFilippis MD ; MSc^?/sup> ;   ; ^&dagger ; ; Michael J.  ; Blaha MD ; MPH^?/sup> ; Chiadi E.  ; Ndumele MD^?/sup> ; Matthew J.  ; Budoff MD^&Dagger ; ; Donald M.  ; Lloyd-Jones MD ; ScM^§ ; ; Robyn L.  ; McClelland PhD^?/sup> ; Susan G.  ; Lakoski MD ; MS^¶ ; ; Mary  ; Cushman MD^# ; Nathan D.  ; Wong PhD^?? ; Roger S.  ; Blumenthal MD^?/sup> ; Joao  ; Lima MD ; MBA^&dagger ; &dagger ; ; Khurram  ; Nasir MD ; MPH^&Dagger ; &Dagger ; ;   ; ^{knasir1@jhmi.edu}
• 关键词：calcium progression ; coronary artery ; Framingham risk score ; Reynolds risk score ; risk prediction ; subclinical atherosclerosis
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：8 November 2011
• 年：2011
• 卷：58
• 期：20
• 页码：2076-2083
• 全文大小：279 K

文摘

Objectives

The purpose of this study was to compare the association of the Framingham risk score (FRS) and Reynolds risk score (RRS) with subclinical atherosclerosis, assessed by incidence and progression of coronary artery calcium (CAC).

Background

The comparative effectiveness of competing risk algorithms for identifying subclinical atherosclerosis is unknown.

Methods

MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 participants free of baseline cardiovascular disease. All participants underwent risk factor assessment, as well as baseline and follow-up CAC testing. We assessed the performance of the FRS and RRS to predict CAC incidence and progression using relative risk and robust linear regression.

Results

The study population included 5,140 individuals (mean age 61 ¡À 10 years, 47 % males, mean follow-up: 3.1 ¡À 1.3 years). Among 53 % of subjects (n = 2,729) with no baseline CAC, 18 % (n = 510) developed incident CAC. Both the FRS and RRS were significantly predictive of incident CAC (relative risk: 1.40 [95 % confidence interval (CI): 1.29 to 1.52] and 1.41 [95 % CI: 1.30 to 1.54] per 5 % increase in risk, respectively) and CAC progression (mean CAC score change: 6.92 [95 % CI: 5.31 to 8.54] and 6.82 [95 % CI: 5.51 to 8.14] per 5 % increase). Discordance in risk category classification (<10 % or >10 % per 10-year coronary heart disease risk) occurred in 13.7 % , with only the RRS consistently adding predictive value for incidence and progression of CAC. These subclinical atherosclerosis findings are supported by a coronary heart disease events analysis over a mean follow-up of 5.6 ¡À 0.7 years.

Conclusions

Both the RRS and FRS predict onset and progression of subclinical atherosclerosis. However, the RRS may provide additional predictive information when discordance between the scoring systems exists.