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Title: | Coronary artery calcium scoring in cardiovascular risk assessment of people with family histories of early onset coronary artery disease. | Authors: | Tonkin A.M.;Huynh Q.;Nicholls S.J.;Mitchell G.K.;Watts G.F.;Marwick T.H.;Venkataraman P.;Stanton T.;Liew D. | Institution: | (Venkataraman, Marwick) Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia (Stanton, Mitchell) University of Queensland, Brisbane, QLD, Australia (Liew, Nicholls, Tonkin) Monash University, Melbourne, VIC, Australia (Huynh) Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (Nicholls) Monash Medical Centre, Melbourne, VIC, Australia (Watts) University of Western Australia, Perth, WA, Australia | Issue Date: | 25-Aug-2020 | Copyright year: | 2020 | Publisher: | John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United States) | Place of publication: | Australia | Publication information: | Medical Journal of Australia. 213 (4) (pp 170-177), 2020. Date of Publication: 01 Aug 2020. | Journal: | Medical Journal of Australia | Abstract: | Objectives: To assess the predictive value of the Australian absolute cardiovascular disease risk (ACVDR) calculator and other assessment tools for identifying Australians with family histories of early onset coronary artery disease (CAD) who have coronary artery calcification. Design, setting, participants: People without known CAD were recruited at seven Australian hospitals, October 2016 - January 2019. Participants were aged 40-70 years, had a family history of early onset CAD, and a 5-year ACVDR of 2-15%. Main Outcome Measure(s): CT coronary artery calcium score greater than zero (any coronary calcification) or greater than 100 (calcification warranting lipid therapy). Result(s): 1059 participants were recruited; 477 (45%) had non-zero coronary artery calcium scores (median 5-year ACVDR, 4.8% [IQR, 2.9-7.6%]; median coronary artery calcium score, 41.7 [IQR, 8-124]); 582 (55%) did not (median 5-year ACVDR, 3.2% [IQR, 2.0-4.6%]). Of 151 participants with calcium scores of 100 or more, 116 (77%) were deemed to be at low cardiovascular risk by Australian guidelines, while 14 of 75 participants at intermediate risk (19%) had zero calcium scores. The sensitivity of the ACVDR calculator for identifying people with non-zero calcium scores (area under receiver operator curve [AUC], 0.674) was lower than that of the pooled cohort equation (AUC, 0.711; P < 0.001). ACVDR (10-year)- and Multi-Ethnic Study of Atherosclerosis (MESA)-predicted risk categories concurred for 511 participants (48%); classifications were concordant for 925 participants (87%) when the ACVDR was supplemented by calcium scores. Conclusion(s): Coronary artery calcium scoring should be considered as part of the heart health check for patients at intermediate ACVDR risk and with family histories of early onset CAD. Alternative risk calculators may better select such patients for further diagnostic testing and primary prevention therapy. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN 12614001294640; 11 December 2014 (prospective).Copyright © 2020 AMPCo Pty Ltd | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.5694/mja2.50702 | PubMed URL: | 32729135 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32729135] | ISSN: | 0025-729X | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29182 | Type: | Article | Subjects: | diagnostic test accuracy study *family history female human major clinical study male coronary artery calcification *coronary artery calcium score *coronary artery disease/di [Diagnosis] *coronary artery disease/dt [Drug Therapy] sensitivity and specificity hydroxymethylglutaryl coenzyme A reductase inhibitor/dt [Drug Therapy] computed tomography scanner adult aged article cardiovascular disease assessment *cardiovascular risk cohort analysis controlled study middle aged predictive value receiver operating characteristic *risk assessment diagnostic test accuracy study family history coronary artery calcification coronary artery calcium score coronary artery disease hydroxymethylglutaryl coenzyme A reductase inhibitor computed tomography scanner aged cardiovascular disease assessment cardiovascular risk receiver operating characteristic sensitivity and specificity adult aged Article cardiovascular disease assessment *cardiovascular risk cohort analysis controlled study coronary artery calcification *coronary artery calcium score *coronary artery disease / *diagnosis / *drug therapy diagnostic test accuracy study *family history female human major clinical study male middle aged predictive value receiver operating characteristic *risk assessment |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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