Predictive Value of Updating Framingham Risk Scores with Novel Risk Markers in the U.S. General Population

• Published in: PloS one Vol. 9; no. 2; p. e88312
• Main Authors: Ferket, Bart S., van Kempen, Bob J. H., Hunink, M. G. Myriam, Agarwal, Isha, Kavousi, Maryam, Franco, Oscar H., Steyerberg, Ewout W., Max, Wendy, Fleischmann, Kirsten E.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.02.2014; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Ankle; Ankle Brachial Index; Biology; Biomarkers - metabolism; Blood pressure measurement; C-reactive protein; Calcium; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Carotid Intima-Media Thickness; Cohort analysis; Cohort Studies; Coronary heart disease; Cost analysis; Cost benefit analysis; Female; Health risk assessment; Health risks; Humans; Male; Markers; Medicine; Meta-analysis; Middle Aged; Nutrition; Nutrition Surveys; Population statistics; Population studies; Predictive Value of Tests; Proportional Hazards Models; Reclassification; Risk assessment; Risk Factors; Surveys; Systematic review; Treatment Outcome; United States - epidemiology; United States; San Francisco California; Netherlands; California; United States > US; Massachusetts
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0088312

According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C- reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U.S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population. Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56±11 years, 48% male), 70% (80%) were at low (<10%), 19% (14%) at intermediate (≥10-<20%), and 11% (6%) at high (≥20%) 10-year CVD (CHD) risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02-0.19). The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01-0.03) with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38%) moved to low and 22% (30%) to high CVD (CHD) risk. Improvements with other novel risk markers were limited. Only CTCS appeared to have significant incremental predictive value in the U.S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies.