Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10362/149270 |
Resumo: | Abstract Objective To evaluate the performance of traditional cardiovascular (CV) risk factors in identifying a higher than expected coronary atherosclerotic burden. Methods We assessed 2069 patients undergoing coronary CT angiography, with assessment of calcium score (CS), for suspected coronary artery disease. A higher than expected atherosclerotic burden was defined as CS >75th percentile (CS >P75) according to age and gender-adjusted monograms. The ability of traditional CV risk factors to predict a CS >P75 was assessed in a customized logistic regression model ("Clinical Score") and by the calculation of SCORE (Systemic Coronary Risk Evaluation). The population attributable risk (PAR) of risk factors for CS >P75 was calculated. Results The median CS was 3.0 (IQR 0.0-98.0); 362 patients had CS >P75. The median SCORE was 3.0 (IQR 1.0-4.0). With the exception of hypertension, all traditional CV risk factors were independent predictors of CS >P75: diabetes, dyslipidemia, smoking and family history (OR 1.3-2.2, p≤0.026). The areas under the ROC curves for CS >P75 were 0.64 for the Clinical Score (95% CI 0.61-0.67, p<0.001) and 0.53 for SCORE (95% CI 0.50-0.56, p=0.088). About a quarter of patients with CS >P75 were in the two lower quartiles of the Clinical Score. Altogether, the traditional risk factors explain 56% of the prevalence of CS >P75 (adjusted PAR 0.56). Conclusion Despite the association of CV risk factors with a higher than expected atherosclerotic burden, they appear to explain only half of its prevalence. Even when integrated in scores, the predictive power of these risk factors was modest, exposing the limitations of risk stratification based solely on demographic and clinical risk factors. |
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Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burdenAtherosclerotic burdenAttributable riskCalcium scoreCT angiographyRisk factorCardiology and Cardiovascular MedicineSDG 3 - Good Health and Well-beingAbstract Objective To evaluate the performance of traditional cardiovascular (CV) risk factors in identifying a higher than expected coronary atherosclerotic burden. Methods We assessed 2069 patients undergoing coronary CT angiography, with assessment of calcium score (CS), for suspected coronary artery disease. A higher than expected atherosclerotic burden was defined as CS >75th percentile (CS >P75) according to age and gender-adjusted monograms. The ability of traditional CV risk factors to predict a CS >P75 was assessed in a customized logistic regression model ("Clinical Score") and by the calculation of SCORE (Systemic Coronary Risk Evaluation). The population attributable risk (PAR) of risk factors for CS >P75 was calculated. Results The median CS was 3.0 (IQR 0.0-98.0); 362 patients had CS >P75. The median SCORE was 3.0 (IQR 1.0-4.0). With the exception of hypertension, all traditional CV risk factors were independent predictors of CS >P75: diabetes, dyslipidemia, smoking and family history (OR 1.3-2.2, p≤0.026). The areas under the ROC curves for CS >P75 were 0.64 for the Clinical Score (95% CI 0.61-0.67, p<0.001) and 0.53 for SCORE (95% CI 0.50-0.56, p=0.088). About a quarter of patients with CS >P75 were in the two lower quartiles of the Clinical Score. Altogether, the traditional risk factors explain 56% of the prevalence of CS >P75 (adjusted PAR 0.56). Conclusion Despite the association of CV risk factors with a higher than expected atherosclerotic burden, they appear to explain only half of its prevalence. Even when integrated in scores, the predictive power of these risk factors was modest, exposing the limitations of risk stratification based solely on demographic and clinical risk factors.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNDores, HélderDe Araújo Gonçalves, PedroFerreira, António MiguelCarvalho, Maria SaloméSousa, Pedro JerónimoCardim, NunoMarques, HugoPereira Machado, Francisco2023-02-15T22:17:19Z2015-04-012015-04-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article7application/pdfhttp://hdl.handle.net/10362/149270eng0870-2551PURE: 17663359https://doi.org/10.1016/j.repc.2014.08.030info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:31:11Zoai:run.unl.pt:10362/149270Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:53:41.086906Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden |
title |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden |
spellingShingle |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden Dores, Hélder Atherosclerotic burden Attributable risk Calcium score CT angiography Risk factor Cardiology and Cardiovascular Medicine SDG 3 - Good Health and Well-being |
title_short |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden |
title_full |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden |
title_fullStr |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden |
title_full_unstemmed |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden |
title_sort |
Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden |
author |
Dores, Hélder |
author_facet |
Dores, Hélder De Araújo Gonçalves, Pedro Ferreira, António Miguel Carvalho, Maria Salomé Sousa, Pedro Jerónimo Cardim, Nuno Marques, Hugo Pereira Machado, Francisco |
author_role |
author |
author2 |
De Araújo Gonçalves, Pedro Ferreira, António Miguel Carvalho, Maria Salomé Sousa, Pedro Jerónimo Cardim, Nuno Marques, Hugo Pereira Machado, Francisco |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) RUN |
dc.contributor.author.fl_str_mv |
Dores, Hélder De Araújo Gonçalves, Pedro Ferreira, António Miguel Carvalho, Maria Salomé Sousa, Pedro Jerónimo Cardim, Nuno Marques, Hugo Pereira Machado, Francisco |
dc.subject.por.fl_str_mv |
Atherosclerotic burden Attributable risk Calcium score CT angiography Risk factor Cardiology and Cardiovascular Medicine SDG 3 - Good Health and Well-being |
topic |
Atherosclerotic burden Attributable risk Calcium score CT angiography Risk factor Cardiology and Cardiovascular Medicine SDG 3 - Good Health and Well-being |
description |
Abstract Objective To evaluate the performance of traditional cardiovascular (CV) risk factors in identifying a higher than expected coronary atherosclerotic burden. Methods We assessed 2069 patients undergoing coronary CT angiography, with assessment of calcium score (CS), for suspected coronary artery disease. A higher than expected atherosclerotic burden was defined as CS >75th percentile (CS >P75) according to age and gender-adjusted monograms. The ability of traditional CV risk factors to predict a CS >P75 was assessed in a customized logistic regression model ("Clinical Score") and by the calculation of SCORE (Systemic Coronary Risk Evaluation). The population attributable risk (PAR) of risk factors for CS >P75 was calculated. Results The median CS was 3.0 (IQR 0.0-98.0); 362 patients had CS >P75. The median SCORE was 3.0 (IQR 1.0-4.0). With the exception of hypertension, all traditional CV risk factors were independent predictors of CS >P75: diabetes, dyslipidemia, smoking and family history (OR 1.3-2.2, p≤0.026). The areas under the ROC curves for CS >P75 were 0.64 for the Clinical Score (95% CI 0.61-0.67, p<0.001) and 0.53 for SCORE (95% CI 0.50-0.56, p=0.088). About a quarter of patients with CS >P75 were in the two lower quartiles of the Clinical Score. Altogether, the traditional risk factors explain 56% of the prevalence of CS >P75 (adjusted PAR 0.56). Conclusion Despite the association of CV risk factors with a higher than expected atherosclerotic burden, they appear to explain only half of its prevalence. Even when integrated in scores, the predictive power of these risk factors was modest, exposing the limitations of risk stratification based solely on demographic and clinical risk factors. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-04-01 2015-04-01T00:00:00Z 2023-02-15T22:17:19Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10362/149270 |
url |
http://hdl.handle.net/10362/149270 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
0870-2551 PURE: 17663359 https://doi.org/10.1016/j.repc.2014.08.030 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
7 application/pdf |
dc.source.none.fl_str_mv |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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