Abstract 12489: Reclassification of 10-Year Coronary Heart Disease Risk in 5324 Primary Prevention Patients: Ascvd, Rrs versus Mesa-Cac Scores

Abstract

Introduction: Cardiovascular (CV) risk prediction score have provided physicians with powerful screening and prevention tools. Hypothesis: In a large screening program of asymptomatic individuals, we sought to assess the CV risk reclassification provided by comparing multiethnic study on subclinical atherosclerosis-coronary artery calcium scoring (CACS) vs American Heart Association (AHA)-American College of Cardiology (ACC)-Atherosclerotic Cardiovascular Disease (ASCVD) score and Reynolds Risk Score (RRS). Methods: We included all 5324 patients (age 57± 8 years, 76% male and 87% white) who underwent CACS screening in a primary prevention clinic between 3/2016 and 10/2021. 10-year ASCVD, RRS and MESA-CACS scores were calculated and categorized as 0, 1-4.99%, 5-9.99% and ≥10%. Results: Mean MESA-CACS, ASCVD and RRS were 4.9± 5.6%, 6.6 ± 6.2%, and 4.5 ± 4.4%. A total of 2962 (56%) had a CAC of 0 of which 481 (16%) were on statin. MESA-CAC was moderately correlated with ASCVD and RRS (R= 0.65 and 0.62 respectively, both p<0.001, Figure 1a-b). Compared to ASCVD score, using MESA-CACS resulted in a downgraded risk in 1666 (31%) subjects, while 738 (14%) had an upgrade in risk. Similarly, compared to RRS, using MESA-CAC resulted in an upgraded risk in 797 (15%) and a downgrade in 1380 (26%) subjects. Additionally, 916 subjects (421 and 495 with an ASVCD score between 5-7.5 and 7.5-20% respectively) met criteria for statin therapy, but had CACS of 0, of which 234 (26%) were on a statin. Conclusions: Utilization of MESA-CACS in primary prevention results insignificant reclassification of traditional CV risk scores with, RRS underestimating and ASCVD overestimating the 10 year-coronary heart disease risk. A quarter of patients with ASCVD score 5-20% who were on statins had a CACS of 0; hence CACS can potentially help refine subjects who would best benefit from statin therapy. Fig 1 Distribution of patients with %10-year risk based on MESA CAC score vs ASCVD (A) and RRS (B)