Pooled Cohort Risk Equations Research Articles

Prediction of atherosclerotic cardiovascular disease mortality in a nationally representative cohort using a set of risk factors from pooled cohort risk equations.

The American College of Cardiology/American Heart Association developed Pooled Cohort equations to estimate atherosclerotic cardiovascular disease (ASCVD) risk. It is unclear how well the equations predict ASCVD mortality in a nationally representative cohort. We used the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and Linked Mortality through 2006 (n = 6,644). Among participants aged 40–79 years without ASCVD at baseline, we used Cox proportional hazard models to estimate the 10-year probability of ASCVD death by sex and race-ethnicity (non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA)). We estimated the discrimination and calibration for each sex-race-ethnicity model. We documented 288 ASCVD deaths during 62,335 person years. The Pooled Cohort equations demonstrated moderate to good discrimination for ASCVD mortality, with modified C-statistics of 0.716 (95% CI 0.663–0.770), 0.794 (0.734–0.854), and 0.733 (0.654–0.811) for NHW, NHB and MA men, respectively. The corresponding C-statistics for women were 0.781 (0.718–0.844), 0.702 (0.633–0.771), and 0.789 (CI 0.721–0.857). Modified Hosmer-Lemeshow χ2 suggested adequate calibration for NHW, NHB and MA men, and MA women (p-values: 0.128, 0.295, 0.104 and 0.163 respectively). The calibration was inadequate for NHW and NHB women (p<0.05). In this nationally representative cohort, the Pooled Cohort equations performed adequately to predict 10-year ASCVD mortality for NHW and NHB men, and MA population, but not for NHW and NHB women.

Comparison of validation and application on various cardiovascular disease mortality risk prediction models in Chinese rural population

This research aims to assess application of different cardiovascular disease (CVD) mortality risk prediction models in Chinese rural population. Data was collected from a 6-year follow-up survey in rural area of Henan Province, China. 10338 participants aged 40 to 65 years were included. Baseline study was conducted between 2007 and 2008, and followed up from 2013 to 2014. Seven models: general Framingham risk score (general-FRS), simplified-FRS, Systematic Coronary Risk Evaluation for high (SCORE-high), SCORE-low, Chinese ischemic CVD (CN-ICVD), Pooled Cohort Risk Equation for white (PCE-white) and for African-American (PCE-AA) were assessed and recalibrated. The model performance was evaluated by C-statistics and modified Nam-D’Agostino test. 168 CVD deaths occurred during follow-up. All seven models showed moderate C-statics ranging from 0.727 to 0.744. Following recalibration, general-FRS, simplified-FRS, CN-ICVD, PCE-white and PCE-AA had improved C-statistics of 0.776, 0.795, 0.793, 0.779, and 0.776 for men and 0.756, 0.753, 0.755, 0.758 and 0.760 for women, respectively. Calibrations χ2 of general-FRS, simplified-FRS, SCORE-high, CN-ICVD and PCE-AA model for men, and general-FRS, CN-ICVD and PCE-white model for women were statistically acceptable, indicating these models predicts CVD mortality risk more accurately than others and could be recommended in Chinese rural population.

Abstract P254: Willingness to Restart Statins: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction: Many patients who discontinue statins due to side effects can restart treatment without the return of side effects. However, statin rechallenge is often met with resistance. Statins are associated with a larger absolute cardiovascular disease (CVD) risk reduction among high risk individuals, but it is unclear whether individuals with higher CVD risk are more willing to be rechallenged. Methods: Between 2014 and 2016, 12,604 participants in theREasons for Geographic and Racial Differences in Stroke study completed a study examination and a questionnaire about their experiences with statins. Of 6,947 participants who reported ever having taken a statin, this analysis included the 688 (9.9%) who reported having discontinued treatment due to side effects and who were not currently taking a statin. We asked participants whether they would be willing to restart a statin, and among those who answered no, we asked whether they were willing to restart at a lower dose or less frequently. Data from the study examination were used to define CVD risk factors and 10-year predicted CVD risk was calculated using the Pooled Cohort risk equations. Results: Participant mean age was 62.4 years, 29.6% were African American, and 66.4% were women. Overall, 26.0% (n=179) of participants were willing to be rechallenged with a statin (Table) . After adjustment for sociodemographic characteristics, older age, cigarette smoking, hypertension, diabetes, or history of CVD were not associated with an increased willingness to be rechallenged with a statin (Table) . Higher 10-year predicted CVD risk was also not associated with willingness to be rechallenged. Conclusions: Over a quarter of participants who discontinued statin treatment due to side effects were willing to be rechallenged. The presence of CVD risk factors and higher predicted CVD risk were not associated with increased willingness to be rechallenged with a statin.

Performance of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations by Social Deprivation Status.

BackgroundThe atherosclerosis cardiovascular disease (ASCVD) Pooled Cohort risk equations have shown different calibration across US populations with varied levels of social deprivation.Methods and ResultsWe analyzed the calibration and discrimination of the Pooled Cohort risk equations by social deprivation status among 9066 REGARDS (REasons for Geographic And Racial Differences in Stroke) study participants not taking statins for whom ASCVD risk may lead to statin initiation. Patients were aged 45 to 79 years, had no ASCVD or diabetes mellitus, and had a low‐density lipoprotein cholesterol level 70 to 189 mg/dL. Social deprivation was defined using 3 indicators: annual household income <$25 000, less than a high school education, and living without a partner. At baseline in 2003–2007, 54.6%, 27.4%, and 18.0% of participants had 0, 1, and 2 or 3 indicators showing deprivation, respectively. From baseline through December 2012, 457 participants developed ASCVD (nonfatal/fatal stroke, myocardial infarction, or coronary heart disease death). Predicted and observed ASCVD incidence per 1000 person‐years were 8.02 and 6.23 (95% CI, 5.31–7.31), respectively, among participants with 0 indicators of deprivation (Hosmer–Lemeshow P=0.01); 8.05 and 6.61 (95% CI, 5.29–8.24), respectively, with 1 indicator (P=0.09); and 9.83 and 11.40 (95% CI, 9.23–14.05), respectively, with 2 or 3 indicators (P=0.12). The C‐index (95% CI) was 0.72 (0.69–0.75), 0.73 (0.69–0.78), and 0.70 (0.65–0.75) among participants with 0, 1, and 2 or 3 indicators of deprivation, respectively. The net reclassification improvement after adding deprivation data to the Pooled Cohort risk equations was modest (0.12; 95% CI, 0.03–0.21).ConclusionsThe Pooled Cohort risk equations have good calibration among individuals with social deprivation but overestimate ASCVD risk among those with less social deprivation.

LEVELS OF OBESITY AND ACCURACY OF THE ATHEROSCLEROTIC CARDIOVASCULAR RISK EQUATION IN A LARGE COMMUNITY-BASED COHORT

Background: The accuracy of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation for atherosclerotic cardiovascular disease (ASCVD) events across different levels of obesity is not known. Methods: The target population for consideration of primary

The Pooled Cohort Equations 3 Years On

In November 2013, a 10-year risk prediction tool known as the Pooled Cohort Equations (PCE) was released as the foundational basis for cardiovascular prevention guidelines in the United States.1 However, the PCE calculator was soon found to overestimate cardiovascular risk in 3 major contemporary US cohorts: the Physicians’ Health Study, the Women’s Health Study, and the Women’s Health Initiative-Observational Cohort.2 Similar overestimation of risk had already been observed in the MESA (Multi-Ethnic Study of Atherosclerosis) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), 2 contemporary US cohorts used for external validation by the guideline creators. The poor calibration observed in these 5 contemporary external cohorts suggested that overreliance on older data occurred during the guideline modeling process (Figure). Indeed, the PCE were derived from studies that enrolled between 1968 and 1990. These older data do not reflect the lower current rates of cardiovascular disease that largely result from secular shifts in smoking, diet, exercise, and blood pressure control, issues of which the prevention community and professional societies should rightly be proud. Figure. US death rates per 100 000 from cardiovascular disease (CVD) and coronary heart disease (CHD). The Pooled Cohort Equations were developed with data from studies that enrolled between 1968 and 1990. However, cardiovascular event rates have significantly declined over the past 40 years, which may explain why overestimation of risk has been seen when these equations are evaluated in contemporary external validation cohorts. The issue of overestimation with the PCE risk calculator …

Dietary Behavior and Predicted 10-Year Risk for a First Atherosclerotic Cardiovascular Disease Event Using the Pooled Cohort Risk Equations Among US Adults

The pooled cohort equations were developed in 2013 by the American College of Cardiology/American Heart Association Task Force to predict an individual's 10-year risk of an atherosclerotic cardiovascular disease (ASCVD) event. The purpose of the present study was to evaluate how predicted 10-year ASCVD event risk varies as a function of daily dietary behavior. Cross-sectional. National Health and Nutrition Examination Survey 2003 to 2006. A total of 2362 adults aged 40 to 79 years. The ASCVD was assessed via the pooled cohort equations, with the Healthy Eating Index calculated from self-reported dietary behavior. Multivariable linear and logistic regression. Adults in the United States consuming a healthy diet (vs those not consuming a healthy diet) had an 88% increased odds of being at low risk for a future ASCVD event within the next 10 years (odds ratio [OR] = 1.88; 95% confidence interval [CI]: 1.35-2.68; P < .001). Similarly, those eating a healthy diet had a 44% reduced odds of being at high risk for a future ASCVD event within the next 10 years (OR = 0.56; 95% CI: 0.34-0.93; P = .02). Among adults who were free of cardiovascular disease, those with a healthy diet had reduced odds of being at high risk for a 10-year ASCVD event.

The 2013 ACC/AHA Cholesterol Management Guideline: Clearing the Confusion from Noncontroversial Components.

The 2013 cholesterol-management guideline from the American College of Cardiology (ACC)/American Heart Association (AHA) was published in November 2013.1 On the basis of high-quality evidence and data from randomized controlled trials, this guideline recommends a risk–benefit discussion regarding statin therapy in 4 statin-benefit groups: patients with atherosclerotic cardiovascular disease (ASCVD); patients with low-density-lipoprotein cholesterol (LDL-C) levels ≥190 mg/dL; patients with diabetes mellitus of age 40 to 75 years; and patients with estimated 10-year ASCVD risk ≥7.5% on the basis of an ASCVD risk estimator derived from the pooled-cohort risk equation. Moderate- to high-intensity statin therapy is recommended for these patient groups. Moderate-intensity statin therapy is defined as statin therapy that lowers LDL-C 30% to <50%. High-intensity statin therapy lowers LDL-C ≥50%.

Analysis of three risk stratification systems in a Saudi population

IntroductionCoronary artery disease is the leading cause of death worldwide. Although there are a number of algorithms in use for determining the risk of coronary artery disease and thus predicting future cardiovascular events, the data available regarding their validity among the Saudi population are insufficient. ObjectiveWe studied the validity of three clinical score systems in predicting a high risk population defined as having excessive coronary calcification: the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation, the Framingham Risk Score, and the European Systematic Coronary Risk Evaluation. MethodsWe analyzed data from 462 patients aged ⩾40years. High-risk features were if the Coronary Calcium Score was either >400 or in the ⩾75th percentile using Multi-Ethnic Study of Atherosclerosis (MESA) score. The scores for the three algorithms were then calculated using the participants’ clinical data. ResultsA total of 87 (18.8%) patients were positive for coronary calcification. Among them, 60 (13%) were classified as being at high risk according to the MESA score. Analyzing these patients by the ACC/AHA Pooled Cohort Risk Equation resulted in nine (15%) as being at low risk, 12 (20%) at intermediate risk, and 39 (65%) at high risk. The Framingham Risk classification resulted in 14 (23%) being at low risk, 13 (22%) at intermediate risk, and 33 (55%) at high risk. The European Systematic Coronary Risk Evaluation risk classification showed 24 (40%) at low risk, 12 (20%) at intermediate risk, and 24 (40%) at high risk, with p<0.0001. ConclusionThe ACC/AHA Pooled Cohort Risk Equation has superior risk ​ calibration compared to the other two risk-score algorithms in a Saudi population.

28. Validity of three risk stratification systems in a Saudi population

Coronary artery disease (CAD) is the leading cause of death worldwide. Although there are a number of algorithms in use for determining risk and thus predicting future cardiovascular events, the data available regarding their validity among the Saudi population are insufficient. We studied the validity of three clinical score systems that are used to define high-risk patient groups: the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation, the Framingham risk score (FRS), and the European Systematic Coronary Risk Evaluation (SCORE).The new ACC/AHA Pooled Cohort Risk Equation can define high risk group among Saudi population better than the older risk stratification systems.We analyzed data from 462 patients aged ⩾40 years with no previous history of CAD. High-risk features were a coronary calcium score (CCS) of ⩾400 or, if the CCS was in the ⩾75 percentile using Multi-Ethnic Study of Atherosclerosis (MESA) score. The scores for the three algorithms were then calculated using the participants’ clinical data and lipid profiles, which had been obtained before performing computed tomography.In all, 87 (18.8%) patients were positive for coronary calcification. Among them, 60 (13%) were classified as being at high risk according to the MESA score. Analyzing these patients by The ACC/AHA Pooled Cohort Risk Equation resulted in 9 (15%) as being at low risk, 12 (20%) at intermediate risk, and 39 (65%) at high risk. The FRM risk classification resulted in 14 (23%) being at low risk, 13 (22%) at intermediate risk, and 33 (55 %) at high risk. The SCORE risk classification showed 24 (40%) at low risk, 12 (20%) at intermediate risk, and 24 (40%) at high risk, with P<0.0001.shown in the figure below.The ACC/AHA Pooled Cohort Risk Equation defined the higher risk group of patients in the Saudi population significantly better than the other two risk-score algorithms.

Accuracy of the Atherosclerotic Cardiovascular Risk Equation in a Large Contemporary, Multiethnic Population

BackgroundThe accuracy of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation for atherosclerotic cardiovascular disease (ASCVD) events in contemporary and ethnically diverse populations is not well understood. ObjectivesThe goal of this study was to evaluate the accuracy of the 2013 ACC/AHA Pooled Cohort Risk Equation within a large, multiethnic population in clinical care. MethodsThe target population for consideration of cholesterol-lowering therapy in a large, integrated health care delivery system population was identified in 2008 and followed up through 2013. The main analyses excluded those with known ASCVD, diabetes mellitus, low-density lipoprotein cholesterol levels <70 or ≥190 mg/dl, prior lipid-lowering therapy use, or incomplete 5-year follow-up. Patient characteristics were obtained from electronic medical records, and ASCVD events were ascertained by using validated algorithms for hospitalization databases and death certificates. We compared predicted versus observed 5-year ASCVD risk, overall and according to sex and race/ethnicity. We additionally examined predicted versus observed risk in patients with diabetes mellitus. ResultsAmong 307,591 eligible adults without diabetes between 40 and 75 years of age, 22,283 were black, 52,917 were Asian/Pacific Islander, and 18,745 were Hispanic. We observed 2,061 ASCVD events during 1,515,142 person-years. In each 5-year predicted ASCVD risk category, observed 5-year ASCVD risk was substantially lower: 0.20% for predicted risk <2.50%; 0.65% for predicted risk 2.50% to <3.75%; 0.90% for predicted risk 3.75% to <5.00%; and 1.85% for predicted risk ≥5.00% (C statistic: 0.74). Similar ASCVD risk overestimation and poor calibration with moderate discrimination (C statistic: 0.68 to 0.74) were observed in sex, racial/ethnic, and socioeconomic status subgroups, and in sensitivity analyses among patients receiving statins for primary prevention. Calibration among 4,242 eligible adults with diabetes was improved, but discrimination was worse (C statistic: 0.64). ConclusionsIn a large, contemporary “real-world” population, the ACC/AHA Pooled Cohort Risk Equation substantially overestimated actual 5-year risk in adults without diabetes, overall and across sociodemographic subgroups.

VALIDATION OF THE ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) POOLED COHORT RISK EQUATIONS BY EDUCATION LEVEL: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY

The Pooled Cohort risk equations were developed to estimate 10-year ASCVD risk and guide prevention measures. Socio-economic (SES) factors such as education are known independent risk factors for ASCVD. We assessed the calibration of the Pooled Cohort risk equations across different education levels

Development and Validation of Risk Prediction Models for Cardiovascular Events in Black Adults: The Jackson Heart Study Cohort.

Cardiovascular risk assessment is a fundamental component of prevention of cardiovascular disease (CVD). However, commonly used prediction models have been formulated in primarily or exclusively white populations. Whether risk assessment in black adults is dissimilar to that in white adults is uncertain. To develop and validate risk prediction models for CVD incidence in black adults, incorporating standard risk factors, biomarkers, and subclinical disease. The Jackson Heart Study (JHS), a longitudinal community-based study of 5301 black adults in Jackson, Mississippi. Inclusive study dates were the date of a participant's first visit (September 2000 to March 2004) to December 31, 2011. The median (75th percentile) follow-up was 9.1 (9.7) years. The dates of the analysis were August 2013 to May 2015. Measurements included standard risk factors, including age, sex, body mass index, systolic and diastolic blood pressure, ratio of fasting total cholesterol to high-density lipoprotein cholesterol, estimated glomerular filtration rate, antihypertensive therapy, diabetes mellitus, and smoking; blood biomarkers; and subclinical disease measures, including ankle-brachial index, carotid intimal-medial thickness, and echocardiographic left ventricular hypertrophy and systolic dysfunction. Incident CVD event was defined as the first occurrence of myocardial infarction, coronary heart disease death, congestive heart failure, stroke, incident angina, or intermittent claudication. Model performance was compared with the American College of Cardiology/American Heart Association (ACC/AHA) CVD risk algorithm and the Framingham Risk Score (FHS) refitted to the JHS data and evaluated in the Atherosclerosis Risk in Communities (ARIC) and Multi-Ethnic Study of Atherosclerosis cohorts. The study cohort comprised 3689 participants with mean (SD) age at baseline was 53 (11) years, and 64.8% (n = 2390) were female. Over a median of 9.1 years, 270 participants (166 women) experienced a first CVD event. A simple combination of standard CVD risk factors, B-type natriuretic peptide, and ankle-brachial index (model 6) yielded modest improvement over a model without B-type natriuretic peptide and ankle-brachial index (C statistic, 0.79; 95% CI, 0.75-0.83 [relative integrated discrimination improvement, 0.22; 95% CI, 0.15-0.30]). However, the reclassification improvement was not substantially different between model 6 and the ACC/AHA CVD Pooled Cohort risk equations or between model 6 and the FHS. The models discriminated reasonably well in the ARIC and Multi-Ethnic Study of Atherosclerosis data (C statistic range, 0.70-0.77). Our findings using the JHS data in the present study are valuable because they confirm that current FHS and ACC/AHA risk algorithms work well in black individuals and are not easily improved on. A unique risk calculator for black adults may not be necessary.

Digital Mammography and Screening for Coronary Artery Disease

ObjectivesThis study sought to determine if breast arterial calcification (BAC) on digital mammography predicts coronary artery calcification (CAC). BackgroundBAC is frequently noted but the quantitative relationships to CAC and risk factors are unknown. MethodsA total of 292 women with digital mammography and nongated computed tomography was evaluated. BAC was quantitatively evaluated (0 to 12) and CAC was measured on computed tomography using a 0 to 12 score; they were correlated with each other and the Framingham Risk Score (FRS) and the 2013 Cholesterol Guidelines Pooled Cohort Equations (PCE). ResultsBAC was noted in 42.5% and was associated with increasing age (p < 0.0001), hypertension (p = 0.0007), and chronic kidney disease (p < 0.0001). The sensitivity, specificity, positive and negative predictive values, and accuracy of BAC >0 for CAC >0 were 63%, 76%, 70%, 69%, and 70%, respectively. All BAC variables were predictive of the CAC score (p < 0.0001). The multivariable odds ratio for CAC >0 was 3.2 for BAC 4 to 12, 2.0 for age, and 2.2 for hypertension. The agreements of FRS risk categories with CAC and BAC risk categories were 57% for CAC and 55% for BAC; the agreement was 47% for PCE risk categories for CAC and 54% by BAC. BAC >0 had area under the curve of 0.73 for identification of women with CAC >0, equivalent to both FRS (0.72) and PCE (0.71). BAC >0 increased the area under the curve curves for FRS (0.72 to 0.77; p = 0.15) and PCE (0.71 to 0.76; p = 0.11) for the identification of high-risk (4 to 12) CAC. With the inclusion of 33 women with established CAD, BAC >0 was significantly additive to both FRS (p = 0.02) and PCE (p = 0.04) for high-risk CAC. ConclusionsThere is a strong quantitative association of BAC with CAC. BAC is superior to standard cardiovascular risk factors. BAC is equivalent to both the FRS and PCE for the identification of high-risk women and is additive when women with established CAD are included.

Abstract P199: Performance of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations by Socioeconomic Status. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Background: The Pooled Cohort risk equations over predict atherosclerosis cardiovascular disease (ASCVD) risk in some contemporary cohorts but not in others. ASCVD risk differs by socioeconomic status (SES) which may influence the performance of the risk equations. We analyzed the performance of the Pooled Cohort risk equations by SES and tested whether adding SES improves the discrimination of the Pooled Cohort risk equations. Methods: We used data from black and white participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study from 2003 to 2007 (all participants ≥45 years of age). The analysis was restricted to participants for whom ASCVD risk may lead to consideration of statin initiation (45-79 years of age without ASCVD or diabetes, LDL cholesterol 70-189 mg/dL, and not taking lipid-lowering medications, N=10,231). SES was assessed using data on living alone, education and household income. Incident ASCVD (fatal/non-fatal stroke, MI or CHD death) was adjudicated through December 2012. Results: The Pooled Cohort risk equations were well calibrated among participants with low SES but over predicted ASCVD risk among participants with higher SES (Table). Discrimination of the equations improved after adding household income (continuous net reclassification improvement: 0.12 [95% CI: 0.03, 0.21]) but not living alone (0.06 [-0.03, 0.14]), or education (-0.04 [-0.13, 0.06]). The continuous net reclassification improvement was 0.10 (95% CI: 0.02, 0.19) after adding the cumulative number of indicators for low SES to the variables in the Pooled Cohort risk equations. Discussion: SES may help explain why the calibration of the Pooled Cohort risk equations has varied across cohorts. Adding information on SES may improve the performance of ASCVD risk equations.

Abstract 16064: Coronary Artery Calcification, Left Atrial, and Left Ventricular Size Measured From Non-contrast Cardiac CT Predict Incident Heart Failure Hospitalization in the General Population

Objective: Non-contrast cardiac computed tomography (CT) is increasingly performed especially in the absence of known cardiac disease. We aimed to determine, whether CT-derived left atrial (LA), left ventricle (LV) size, and coronary artery calcification (CAC) are associated with future hospitalizations due to heart failure (HF). Methods: Subjects without known cardiac diseases from the population based Heinz Nixdorf Recall Study were followed for incident HF hospitalization. From non-contrast cardiac CT, LA and LV area were measured from axial images and indexed by body surface area. Cox regression analysis determined the association of each CT-measure with HF hospitalization in unadjusted and ASCVD-Score (atherosclerotic cardiovascular disease, pooled cohort risk equation) adjusted analysis. Hazard ratios (HR) and 95% confidence intervals are shown per standard deviation of LA/LV area and increase in log(CAC+1) by 1. Results: From 3944 subjects without known cardiac disease (59±8 years, 47% male, mean ASCVD-Score 11.3±10.8%), 31 subjects (0.8%) were hospitalized due to HF during 10.3±2.0 years of follow-up. LA index, LV index, and CAC-score were significantly associated with incident HF hospitalization in unadjusted analysis (LA: 3.24 [1.75-5.99], p=0.0002, LV: 5.65 [3.02-10.57], p&lt;0.0001, CAC: 1.30 [1.12-1.51], p=0.0007). HRs remained significant for all three CT-measures after adjustment for ASCVD-Score (LA: 2.59 [1.36-4.94], p=0.004; LV: 4.19 [2.17-8.08], p&lt;0.0001, CAC: 1.19 [1.01-1.40], p=0.042). Stratifying by age at baseline, association of LA and LV were stronger for younger subjects (&lt;65 years: LA: 4.26 [1.91-9.49], p=0.0004; LV: 7.38 [3.23-16.88], p&lt;0.0001; ≥65 years: LA: 1.40 [0.57-3.48], p=0.5; LV: 3.08 [1.13-8.36], p=0.03) while CAC-score was stronger in older subjects (&lt;65 years: 1.07 [0.84-1.36], p=0.6; ≥65 years: 1.29 [1.01-1.65], p=0.041) in ASCVD-adjusted analysis. Conclusion: LA size, LV size, and CAC-score as measured from non-contrast cardiac CT are associated with incident HF hospitalization in the general population. Once cardiac CT is performed, quantification of LA and LV size may identify subjects at early and subclinical stages of HF that qualify for further cardiac workup, especially in younger age.

Abstract 17992: Observed versus Predicted Myocardial Infarction Among Individuals With Human Immunodeficiency Virus by American College of Cardiology/American Heart Association Pooled Cohort Equation Risk Strata: Center for AIDS Research Network of Integrated Clinical Systems

Background: Human immunodeficiency virus (HIV)-infected individuals are at elevated risk for cardiovascular disease (CVD) due to an interplay between traditional CVD risk factors, chronic inflammation persisting despite HIV viral suppression, and side effects of antiretroviral therapy. Previous studies evaluating CVD risk prediction models in HIV populations have generally been small in size and assessed non-U.S. cohorts. The 2013 ACC/AHA ASCVD Risk Estimator has not been evaluated in a large, multi-center HIV cohort. Hypothesis: Our primary hypothesis was that the ACC/AHA ASCVD Risk Estimator would underestimate ASCVD risk across risk strata for HIV-infected patients. Methods: We evaluated this risk prediction tool in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) multi-center U.S.-based cohort of approximately 30,000 HIV-infected adults with rigorous central adjudication of myocardial infarction (MI) and differentiation between type I and II MI. We compared MI and ASCVD risks predicted by the ASCVD Risk Estimator to actual rates of MI observed in the CNICS cohort. Results: A total of 132 MIs were observed during follow-up, compared with 103 MIs that would have been expected based on the ASCVD risk estimator. Observed MI rates were higher than expected across most predicted risk levels, particularly among black participants and those with low (&lt;5%) predicted 10-year ASCVD risk. This under-prediction was relatively uniform across risk strata among white men; the observed MI rates were 68%, 68%, 67%, and 67% greater than expected, respectively, for white men with &lt;5%, 5% to &lt;7.5%, 7.5% to &lt;10%, and 10% or greater predicted 10-year ASCVD risk. Conclusions: These data suggest that the ACC/AHA Risk Estimator under-predicts MI risk among HIV-infected individuals. The under-prediction was relatively uniform across risk strata for white men. These data highlight the need for accurate HIV-specific CVD risk prediction tools.

Sedentary behavior and predicted 10-yr risk for a first atherosclerotic cardiovascular disease (ASCVD) event using the pooled cohort risk equations among US adults

Sedentary behavior and predicted 10-yr risk for a first atherosclerotic cardiovascular disease (ASCVD) event using the pooled cohort risk equations among US adults

Association of pooled cohort risk scores with vascular inflammation and coronary artery calcification in Korean adults

ObjectivesA new pooled cohort risk equation to estimate atherosclerotic cardiovascular disease (CVD) risk was recently published, but the equation is based primarily on data from Caucasian populations. The relationship of this new risk scoring system with vascular inflammation and calcification has yet to be examined. MethodsA total of 74 participants were retrospectively selected based on inclusion and exclusion criteria. All participants underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and multi-detector computed tomography (MDCT) examination in the Korea University Guro Hospital between June 2009 and May 2013. Vascular inflammation of the carotid artery was measured as target-to-background ratio (TBR) using 18F-FDG-PET/CT and coronary artery calcification was quantified as Agatston score by MDCT. ResultsAgatston scores were not significantly associated with any metabolic risk factors, but maximum TBR values exhibited a significant positive correlation with body mass index (r=0.31, P=0.01), waist circumference (r=0.42, P<0.01), waist-to-hip ratio (r=0.49, P<0.01), and systolic (r=0.35, P<0.01) and diastolic blood pressure (r=0.39, P<0.01). Furthermore, maximum TBR values were significantly correlated with serum high-sensitivity C-reactive protein (hsCRP) levels (r=0.26, P=0.03), whereas Agatston scores had no correlation. When pooled cohort risk equation scores were divided into incremental tertiles, age, waist circumference, waist-to-hip ratio and systolic blood pressure showed significant incremental trends. In particular, pooled cohort risk scores exhibited a significant positive correlation with maximum TBR values (r=0.35, P<0.01), but not with Agatston scores (r=0.11, P=0.34). ConclusionsThe pooled cohort risk equation exhibited significant positive correlations with vascular inflammation but not with calcification in Asian subjects without CVD, suggesting that this novel risk equation may detect early inflammatory changes preceding the structural modification of vessel walls.

Serial measurement of N-terminal pro–B-type natriuretic peptide and cardiac troponin T for cardiovascular disease risk assessment in the Multi-Ethnic Study of Atherosclerosis (MESA)

N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (TnT) predict cardiovascular disease (CVD) risk in a variety of populations. Whether their predictive value varies by ethnicity is unknown. We sought to determine whether NT-proBNP and TnT improve prediction of incident coronary heart disease (CHD) and CVD, independent of CVD risk factors, in a multiethnic population; whether NT-proBNP improves prediction compared with the Framingham Risk Score or the Pooled Cohort Risk Equation; and whether a second NT-proBNP further improves prediction. Both NT-proBNP and TnT were measured in 5,592 MESA white, black, Hispanic, and Chinese participants (60% nonwhite; mean age 62.3 ± 10.3 years) in 2000 to 2002 and 2004 to 2005. We evaluated adjusted risk of incident CHD and CVD based on baseline and change in biomarker concentration. Participants were followed up through 2011 and incurred 370 CVD events (232 CHD). Concentrations of NT-proBNP and TnT varied by ethnicity. Both NT-proBNP and TnT were associated with an increased risk of events (adjusted hazard ratio [HR] for CHD [95% CI] for fifth quintile vs other 4 quintiles of NT-proBNP, 2.03 [1.50-2.76]; HR for CHD for detectable vs undetectable TnT, 3.95 [2.29-6.81]). N-terminal-pro-B-type natriuretic peptide improved risk prediction and classification compared with the Framingham Risk Score and the Pooled Cohort Risk Equation. Change in NT-proBNP was independently associated with events (HR for CHD per unit increase in ΔlogNT-proBNP, 1.95 [1.16-3.26]). None of the observed associations varied by ethnicity. Both NT-proBNP and TnT are predictors of incident CHD, independent of established risk factors and ethnicity, in a multiethnic population without known CVD. Change in NT-proBNP may add additional prognostic information.