TY - JOUR
T1 - Astronaut cardiovascular health and risk modification (Astro-CHARM) coronary calcium atherosclerotic cardiovascular disease risk calculator
AU - Khera, Amit
AU - Budoff, Matthew J.
AU - O'Donnell, Christopher J.
AU - Ayers, Colby A.
AU - Locke, James
AU - de Lemos, James A
AU - Massaro, Joseph M.
AU - McClelland, Robyn L.
AU - Taylor, Allen
AU - Levine, Benjamin D
N1 - Funding Information:
The Astro-CHARM calculator was developed with support from the National Space Biomedical Research Institute through NCC 9-58. The Dallas Heart Study was funded by the Donald W. Reynolds Foundation (Las Vegas, Nevada) and was partially supported by US Public Health Service General Clinical Research Center grant M01-RR00633 from the National Institutes of Health/National Center for Research Resources-Continuing Review. The Framingham Heart Study was supported by the National Heart, Lung, and Blood Institute’s Framingham Heart Study (contract no. N01‐HC‐25195, HL076784, AG028321, HL070100, HL060040, HL080124, HL071039, HL077447, and HL107385). The study sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or
Funding Information:
approval of the manuscript. The MESA study was supported by contracts HH-SN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from National Center for Advancing Translational Science. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. The PACC study was Supported by the Congressionally directed, Peer Reviewed Medical Research Program, grant ERMS 00239017-00216. The opinions or assertions herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.
Funding Information:
The Astro-CHARM calculator was developed with support from the National Space Biomedical Research Institute through NCC 9-58. The Dallas Heart Study was funded by the Donald W. Reynolds Foundation (Las Vegas, Nevada) and was partially supported by US Public Health Service General Clinical Research Center grant M01-RR00633 from the National Institutes of Health/National Center for Research Resources-Continuing Review. The Framingham Heart Study was supported by the National Heart, Lung, and Blood Institute's Framingham Heart Study (contract no. N01-HC-25195, HL076784, AG028321, HL070100, HL060040, HL080124, HL071039, HL077447, and HL107385). The study sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The MESA study was supported by contracts HH-SN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from National Center for Advancing Translational Science. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. The PACC study was Supported by the Congressionally directed, Peer Reviewed Medical Research Program, grant ERMS 00239017-00216. The opinions or assertions herein are the private views of the authors and are not to be construed as refecting the views of the Department of the Army or the Department of Defense.
Publisher Copyright:
© 2018 American Heart Association, Inc.
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - Calcification of joints and arteries
KW - Coronary vessels
KW - Risk assessment
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U2 - 10.1161/CIRCULATIONAHA.118.033505
DO - 10.1161/CIRCULATIONAHA.118.033505
M3 - Article
C2 - 30354651
AN - SCOPUS:85055607933
SN - 0009-7322
VL - 138
SP - 1819
EP - 1827
JO - Circulation
JF - Circulation
IS - 17
ER -