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Khera A, Budoff MJ, O'Donnell CJ, Ayers CA, Locke J, de Lemos JA, Massaro JM, McClelland RL, Taylor A, Levine BD. Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) Coronary Calcium Atherosclerotic Cardiovascular Disease Risk Calculator. Circulation 2019; 138:1819-1827. [PMID: 30354651 DOI: 10.1161/circulationaha.118.033505] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) is a powerful novel risk indicator for atherosclerotic cardiovascular disease (ASCVD). Currently, there is no available ASCVD risk prediction tool that integrates traditional risk factors and CAC. METHODS To develop a CAC ASCVD risk tool for younger individuals in the general population, subjects aged 40 to 65 without prior cardiovascular disease from 3 population-based cohorts were included. Cox proportional hazards models were developed incorporating age, sex, systolic blood pressure, total and high-density lipoprotein cholesterol, smoking, diabetes mellitus, hypertension treatment, family history of myocardial infarction, high-sensitivity C-reactive protein, and CAC scores (Astro-CHARM model [Astronaut Cardiovascular Health and Risk Modification]) as dependent variables and ASCVD (nonfatal/fatal myocardial infarction or stroke) as the outcome. Model performance was assessed internally, and validated externally in a fourth cohort. RESULTS The derivation study comprised 7382 individuals with a mean age 51 years, 45% women, and 55% nonwhite. The median CAC was 0 (25th, 75th [0,9]), and 304 ASCVD events occurred in a median 10.9 years of follow-up. The c-statistic was 0.784 for the risk factor model, and 0.817 for Astro-CHARM ( P<0.0001). In comparison with the risk factor model, the Astro-CHARM model resulted in integrated discrimination improvement (0.0252), and net reclassification improvement (0.121; P<0.0001), as well. The Astro-CHARM model demonstrated good discrimination (c=0.78) and calibration (Nam-D'Agostino χ2, 13.2; P=0.16) in the validation cohort (n=2057; 55 events). A mobile application and web-based tool were developed to facilitate clinical application of this tool ( www.AstroCHARM.org ). CONCLUSION The Astro-CHARM tool is the first integrated ASCVD risk calculator to incorporate risk factors, including high-sensitivity C-reactive protein and family history, and CAC data. It improves risk prediction in comparison with traditional risk factor equations and could be useful in risk-based decision making for cardiovascular disease prevention in the middle-aged general population.
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Affiliation(s)
- Amit Khera
- Department of Internal Medicine (A.K., J.A.d.L., B.D.L.), at the University of Texas Southwestern Medical Center, Dallas, TX.,Division of Cardiology (A.K., J.A.d.L., B.D.L.), at the University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, CA (M.J.B.)
| | - Christopher J O'Donnell
- The National Heart, Lung, and Blood Institute's the Framingham Heart Study, Framingham, Massachusetts; Cardiology Section, Department of Medicine, Boston Veteran's Administration Healthcare (C.J.O.)
| | - Colby A Ayers
- Department of Clinical Sciences (C.A.A.) at the University of Texas Southwestern Medical Center, Dallas, TX
| | - James Locke
- National Aeronautics and Space Agency, Johnson Space Center, Houston, TX (J.L.)
| | - James A de Lemos
- Department of Internal Medicine (A.K., J.A.d.L., B.D.L.), at the University of Texas Southwestern Medical Center, Dallas, TX.,Division of Cardiology (A.K., J.A.d.L., B.D.L.), at the University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Allen Taylor
- Divison of Cardiology, Georgetown University; and MedStar Georgetown University Hospital and MedStar Health Research Institute, Washington, DC (A.T.)
| | - Benjamin D Levine
- Department of Internal Medicine (A.K., J.A.d.L., B.D.L.), at the University of Texas Southwestern Medical Center, Dallas, TX.,Division of Cardiology (A.K., J.A.d.L., B.D.L.), at the University of Texas Southwestern Medical Center, Dallas, TX.,Institute for Exercise and Environmental Medicine, Presbyterian Hospital, Dallas, TX (B.D.L.)
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Zoet GA, Benschop L, Boersma E, Budde RPJ, Fauser BCJM, van der Graaf Y, de Groot CJM, Maas AHEM, Roeters van Lennep JE, Steegers EAP, Visseren FL, van Rijn BB, Velthuis BK, Franx A. Prevalence of Subclinical Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography in 45- to 55-Year-Old Women With a History of Preeclampsia. Circulation 2019; 137:877-879. [PMID: 29459475 DOI: 10.1161/circulationaha.117.032695] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gerbrand A Zoet
- Wilhelmina Children's Hospital Birth Center (G.A.Z., B.B.v.R., A.F.)
| | - Laura Benschop
- Department of Obstetrics and Gynaecology (L.B., E.A.P.S.)
| | | | - Ricardo P J Budde
- Department of Cardiology (E.B., R.P.J.B.).,Department of Radiology (R.P.J.B.)
| | | | | | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, Netherlands (G.J.M.d.G.)
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands (A.H.E.M.M.)
| | | | | | | | - Bas B van Rijn
- Wilhelmina Children's Hospital Birth Center (G.A.Z., B.B.v.R., A.F.).,Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Birgitta K Velthuis
- Department of Radiology (B.K.V.), University Medical Center Utrecht, Netherlands
| | - Arie Franx
- Wilhelmina Children's Hospital Birth Center (G.A.Z., B.B.v.R., A.F.)
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