The Added Value of Coronary Calcium Score in Predicting Cardiovascular Events in Familial Hypercholesterolemia.
JACC Cardiovasc Imaging
; 14(12): 2414-2424, 2021 12.
Article
en En
| MEDLINE
| ID: mdl-34274263
ABSTRACT
OBJECTIVES:
This study aimed at investigating the additional contribution of coronary artery calcium (CAC) score to SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) risk equation (SAFEHEART-RE) for cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH).BACKGROUND:
Common cardiovascular risk equations are imprecise for HeFH. Because of the high phenotype variability of HeFH, CAC score could help to better stratify the risk of atherosclerotic cardiovascular disease (ASCVD).METHODS:
REFERCHOL (French Registry of Familial Hypercholesterolemia) and SAFEHEART are 2 ongoing national registries on HeFH. We analyzed data from primary prevention HeFH patients undergoing CAC quantification. We used probability-weighted Cox proportional hazards models to estimate HRs. Area under the receiver-operating characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare the incremental contribution of CAC score when added to the SAFEHEART-RE for ASCVD prediction. ASCVD was defined as coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, resuscitated sudden death, and cardiovascular death.RESULTS:
We included 1,624 patients (mean age 48.5 ± 12.8 years; men 45.7%) from both registries. After a median follow-up of 2.7 years (interquartile range 0.4-5.0 years), ASCVD occurred in 81 subjects. The presence of a CAC score of >100 was associated with an HR of 32.05 (95% CI 10.08-101.94) of developing ASCVD as compared to a CAC score of 0. Receiving-operating curve analysis showed a good performance of CAC score alone in ASCVD prediction (AUC 0.860 [95% CI 0.853-0.869]). The addition of log(CAC + 1) to SAFEHEART-RE resulted in a significantly improved prediction of ASCVD (AUC 0.884 [95% CI 0.871-0.894] for SAFEHEART-RE + log(CAC + 1) vs AUC 0.793 [95% CI 0.779-0.818] for SAFEHEART-RE; P < 0.001). These results were confirmed also when considering only hard cardiovascular endpoints. The addition of CAC score was associated with an estimated overall net reclassification improvement of 45.4%.CONCLUSIONS:
CAC score proved its use in improving cardiovascular risk stratification and ASCVD prediction in statin-treated HeFH.Palabras clave
Texto completo:
1
Colección:
01-internacional
Asunto principal:
Enfermedad de la Arteria Coronaria
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Aterosclerosis
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Calcificación Vascular
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Hiperlipoproteinemia Tipo II
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
JACC Cardiovasc Imaging
Asunto de la revista:
ANGIOLOGIA
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CARDIOLOGIA
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DIAGNOSTICO POR IMAGEM
Año:
2021
Tipo del documento:
Article