Predicting the risk of coronary artery calcium progression in the general population: insights from the MESA and CARDIA studies

Abstract

AIMCoronary artery calcium (CAC) progression is a strong predictor of cardiovascular disease. This study aims to develop and validate a practical tool for predicting individual CAC progression in the general population. METHODSData were utilized from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, comprising 5486 participants (47.3% male, mean ± SD age: 61.9 ± 10.2 years), who were randomly assigned to either a training set or an internal validation set at a 7:3 ratio. Additionally, a separate cohort of 2447 participants (44.6% male, mean ± SD age: 40.4 ± 3.5 years) from the Coronary Artery Risk Development in Young Adults (CARDIA) study served as the external validation set. A nomogram was developed based on a Cox regression model incorporating 10 variables selected by the least absolute shrinkage and selection operator (LASSO) method to predict CAC progression. RESULTSFrom the 61 features considered, 10 key variables were identified: age, male sex, smoking status, waist circumference, systolic blood pressure, fasting glucose, lipid abnormalities, and the use of antihypertensive, glucose-lowering, and lipid-lowering medications. The nomogram demonstrated good discrimination, with a C-statistic of 0.682 (95% CI, 0.665–0.699) in the training set and 0.750 (95% CI, 0.729–0.771) in the external validation set. Decision curve analysis further confirmed the nomogram’s clinical utility in predicting the risk of CAC progression. CONCLUSIONOur nomogram offers a practical tool for individualized prediction of CAC progression, potentially aiding in the primary prevention of cardiovascular disease in clinical practice. Registration URLhttps://www.clinicaltrials.gov; Unique identifier: NCT00005130 (CARDIA), NCT00005487 (MESA)