Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA, 329(20), 1768. https://doi.org/10.1001/jama.2023.7575 Dr. Sadiya Khan et al.
Points
- This research compared the effectiveness of coronary artery calcium and polygenic risk scores in predicting coronary heart disease (CHD) risk.
- The study analyzed data from two population-based studies involving 3,208 adults aged 45 to 79.
- The results showed that adding a coronary artery calcium score significantly improved risk discrimination, while the polygenic risk score did not have the same effect.
- The coronary artery calcium score outperformed the polygenic risk score regarding CHD risk prediction and showed better discrimination.
- Incorporating the coronary artery calcium score into traditional risk factor-based models significantly improved risk discrimination and reclassification for CHD.
Summary
This research paper aimed to assess the impact of incorporating a coronary artery calcium score and a polygenic risk score into a traditional risk factor-based model on the discrimination of coronary heart disease (CHD) risk. The study utilized data from two population-based studies: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Rotterdam Study (RS), which included 3,208 adults aged 45 to 79 years. The results revealed that adding a coronary artery calcium score significantly improved risk discrimination (MESA: 0.09, RS: 0.06), whereas the polygenic risk score did not exhibit the same effect. These findings were consistent across different age groups.
Identifying novel markers to improve the prediction of coronary heart disease (CHD) risk has led to exploring the coronary artery calcium score and polygenic risk score as potential markers. However, no previous studies have directly compared the performance of these markers within the same cohorts. This research aimed to address this gap by evaluating changes in CHD risk prediction when incorporating a coronary artery calcium score, a polygenic risk score, or both into a traditional risk factor-based model.
The study utilized observational data from the MESA study (1,991 participants) and the RS (1,217 participants). Participants were of European ancestry and free of clinical CHD at baseline. Traditional risk factors, such as pooled cohort equations (PCEs), were used to calculate CHD risk. The results demonstrated that log (coronary artery calcium+1) and the polygenic risk score were significantly associated with the 10-year risk of incident CHD. The coronary artery calcium score exhibited a hazards ratio per standard deviation of 2.60 (95% CI, 2.08-3.26), while the polygenic risk score had a hazards ratio of 1.43 (95% CI, 1.20-1.71) in the MESA cohort. The coronary artery calcium score outperformed the polygenic risk score in discriminating CHD risk, with a C statistic of 0.76 (95% CI, 0.71-0.79) compared to 0.69 (95% CI, 0.63-0.71), respectively. When added to the traditional risk factor-based model, the coronary artery calcium score significantly improved risk discrimination (change in C statistic: 0.09; 95% CI, 0.06-0.13), while the polygenic risk score had a lesser effect (change in C statistic: 0.02; 95% CI, 0.00-0.04). Moreover, the overall categorical net reclassification improvement was significant when the coronary artery calcium score (0.19; 95% CI, 0.06-0.28) but not the polygenic risk score (0.04; 95% CI, -0.05 to 0.10) was added to the traditional risk factor-based model.
In this study involving middle-aged to older adults from the US and the Netherlands, the coronary artery calcium score demonstrated better discrimination than the polygenic risk score in predicting CHD risk. Furthermore, adding the coronary artery calcium score to traditional risk factors significantly improved risk discrimination and reclassification for CHD. These findings suggest that the coronary artery calcium score can be a valuable marker for assessing CHD risk in this population. It emphasizes the importance of incorporating multiple risk factors, including the coronary artery calcium score, in the evaluation of cardiovascular health.
Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2805138
References Khan, S. S., Post, W. S., Guo, X., Tan, J., Zhu, F., Bos, D., Sedaghati-Khayat, B., Van Rooij, J., Aday, A., Allen, N. B., Bos, M. M., Uitterlinden, A. G., Budoff, M. J., Lloyd-Jones, D. M., Mosley, J. D., Rotter, J. I., Greenland, P., & Kavousi, M. (2023). Coronary artery calcium score and polygenic risk score for the prediction of coronary heart disease events. JAMA, 329(20), 1768. https://doi.org/10.1001/jama.2023.7575
