Abstract
BackgroundThe atherosclerotic cardiovascular disease (ASCVD) risk predicted by traditional risk factors is used to guide preventive treatment. We aimed to investigate whether preferable levels of non-traditional emerging risk factors (i.e., negative risk markers) could downgrade the predicted ASCVD risk beyond traditional risk factors.MethodsA total of 7,568 Chinese adults aged ≥ 40 years were followed up during 2010–2015. Negative risk markers including non-traditional lipids, urinary albumin-to-creatinine ratio, electrocardiogram (ECG), and measurements of atherosclerosis were evaluated using diagnostic likelihood ratio (DLR) and continuous net reclassification index (NRI) for their ability to downshift predicted CVD risk in the overall study population and in participants with intermediate (traditional risk factor predicted ASCVD risk 7.5% to 19.9%) or high risk (≥20%).ResultsDuring a median follow-up of 4.5 years, 416 participants developed CVD events including non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. Among negative risk markers examined, lipoprotein(a) ≤ 10th percentile (5 mg/dL), normal ECG, and carotid intima-media thickness (CIMT) ≤ 25th percentile (0.5 mm) provided moderate CVD risk reclassification and downward changes in pre- to post-test risk on top of the traditional CVD risk factors, especially in high-risk participants. The DLRs were 0.41, 0.75, and 0.41, and the NRIs were 18, 22, and 14% for lipoprotein(a), ECG, and CIMT, respectively in high-risk participants.ConclusionsLipoprotein(a) ≤ 5 mg/dL, normal ECG, and CIMT ≤ 0.5 mm might be used as negative non-traditional risk markers to correctly downgrade predicted ASCVD risk in Chinese adults.
Highlights
Cardiovascular disease (CVD) is a major health challenge for the modern society
We aimed to investigate whether preferable levels of non-traditional emerging risk factors could downgrade the predicted atherosclerotic CVD (ASCVD) risk beyond traditional risk factors
Lipoprotein(a) ≤5 mg/dL, normal ECG, and carotid intima-media thickness (CIMT) ≤0.5 mm might be used as negative non-traditional risk markers to correctly downgrade predicted ASCVD risk in Chinese adults
Summary
Cardiovascular disease (CVD) is a major health challenge for the modern society. The total prevalent cases of CVD are ∼523 million globally in 2019 and 18.6 million people die of CVD each year [1]. A well-known example is the Pooled Cohort Equations (PCEs) for 10-year atherosclerotic CVD (ASCVD) risk calculated using traditional CVD risk factors recommended by the American College of Cardiology/American Heart Association (ACC/AHA) [2]. Preventive medications such as statins are recommended in people with elevated ASCVD risk predicted using the PCEs [4, 5]. A previous study found that a coronary artery calcium (CAC) score of 0 was associated with a reduced CVD risk and defined CAC = 0 as a negative risk marker [7]. The atherosclerotic cardiovascular disease (ASCVD) risk predicted by traditional risk factors is used to guide preventive treatment. We aimed to investigate whether preferable levels of non-traditional emerging risk factors (i.e., negative risk markers) could downgrade the predicted ASCVD risk beyond traditional risk factors
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