Evaluation of Newer Risk Markers for Coronary Heart Disease Risk Classification A Cohort Study

Maryam Kavousi, Suzette Smale, Joost Rutten, Maarten Leening, R (Rozemarijn) Vliegenthart, Germaine Verwoert, Gabriel Krestin, M Oudkerk, Moniek de Maat, Frank Leebeek, F.U.S. Mattace Raso, Jan Lindemans, Bert Hofman, Ewout Steyerberg, Aad van der Lugt, Ton van den Meiracker, JCM Witteman

Research output: Contribution to journalArticleAcademicpeer-review

273 Citations (Scopus)


Background: Whether newer risk markers for coronary heart disease (CHD) improve CHD risk prediction remains unclear. Objective: To assess whether newer risk markers for CHD risk prediction and stratification improve Framingham risk score (FRS) predictions. Design: Prospective population-based study. Setting: The Rotterdam Study, Rotterdam, the Netherlands. Participants: 5933 asymptomatic, community-dwelling participants (mean age, 69.1 years [SD, 8.5]). Measurements: Traditional CHD risk factors used in the FRS (age, sex, systolic blood pressure, treatment of hypertension, total and high-density lipoprotein cholesterol levels, smoking, and diabetes) and newer CHD risk factors (N-terminal fragment of prohormone B-type natriuretic peptide levels, von Willebrand factor antigen levels, fibrinogen levels, chronic kidney disease, leukocyte count, C-reactive protein levels, homocysteine levels, uric acid levels, coronary artery calcium [CAC] scores, c Results: Adding CAC scores to the FRS improved the accuracy of risk predictions (c-statistic increase, 0.05 [95% CI, 0.02 to 0.06]; net reclassification index, 19.3% overall [39.3% in those at intermediate risk, by FRS]). Levels of N-terminal fragment of prohormone B-type natriuretic peptide also improved risk predictions but to a lesser extent (c-statistic increase, 0.02 [CI, 0.01 to 0.04]; net reclassification index, 7.6% overall [33.0% in those at intermediate risk, by FRS]). Improvements in Limitation: The findings may not be generalizable to younger or nonwhite populations. Conclusion: Among 12 CHD risk markers, improvements in FRS predictions were most statistically and clinically significant with the addition of CAC scores. Further investigation is needed to assess whether risk refinements using CAC scores lead to a meaningful change in clinical outcome. Whether to use CAC score screening as a more routine test for risk prediction requires full consideration of the financial and clinical costs of performing versus not performing the test for both persons and heal
Original languageUndefined/Unknown
Pages (from-to)438-444
Number of pages7
JournalAnnals of Internal Medicine
Issue number6
Publication statusPublished - 2012

Cite this