General Cardiovascular Risk Profile Identifies Advanced Coronary Artery Calcium and Is Improved by Family History

The Multiethnic Study of Atherosclerosis

Published in: Circulation: Cardiovascular genetics, v. 3, no. 1, Feb. 2010, p. 97-105

Posted on on January 01, 2010

by Maren T. Scheuner, Claude Messan Setodji, James S Pankow, Roger S. Blumenthal, Emmett B. Keeler

Read More

Access further information on this document at Circulation: Cardiovascular genetics

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: The General Cardiovascular Risk Profile (GCRP) is a multivariable model that predicts global cardiovascular disease risk. Our goal was to assess the ability of the GCRP to identify individuals with advanced coronary artery calcification (CAC), and determine whether identification is improved with family history. METHODS AND RESULTS: Using data from the Multi-Ethnic Study of Atherosclerosis, three sex-specific models were developed with ordinal logistic regressions to relate risk factors to CAC scores. Model 1 included covariates in the GCRP. Then family history was added, defined as having at least one first-degree relative with premature coronary heart disease (CHD) (Model 2), or as a weak, moderate or strong family history based on number of relatives with CHD, age at onset, and presence of stroke or diabetes in the family (Model 3). For each model, we estimated mathematical CAC risk functions, derived CAC score sheets, evaluated the ability to discriminate persons having positive CAC scores, and assessed reclassification of individuals with low, intermediate, or high probability of CAC >300. Model 1 worked well to identify women and men with positive CAC scores; c-statistics were 0.752 and 0.718 and X2 values were 821.2 (p<0.0001) and 730.6 (p<0.0001), respectively. Addition of family history improved discrimination and fit of Model 1. However, reclassification of participants with advanced CAC was significantly improved with Model 3 only. CONCLUSIONS: The GCRP identifies advanced CAC, an emerging indication for aggressive risk factor modification. Incorporation of family history, especially comprehensive familial risk stratification, provides incremental prognostic value.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.