Novel risk markers—CT looks strong

The primary prevention of cardiovascular disease involves classifying individuals according to their global cardiovascular risk. However, those at intermediate risk represent a particular challenge; while some may require aggressive treatment, others may be best managed by lifestyle measures alone. Biomarkers that have shown promise in improving risk discrimination include carotid intima-media thickness (CIMT), coronary artery calcium (CAC) scoring, brachial flow-mediated dilation (FMD), ankle-brachial index (ABI), high-sensitivity C-reactive protein (CRP) and, in addition, having a family history of coronary heart disease (CHD). Determining whether—and by how much—risk prediction can be improved by various markers could help to determine the most efficient strategy for the use of primary prevention drugs.

One thousand and three hundred and thirty intermediate risk participants (Framingham risk score of >5% and <20% for a coronary event within the next ten years) in the Multi-Ethnic Study of Atherosclerosis were followed up for a mean of 7.6 years. The area under the receiver operator characteristic curve (AUC) and net relassification improvement were used to compare the incremental contributions of each marker when added to Framingham risk score, plus race/ethnicity.

Ninety-four CHD and 123 cardiovascular (CVD) events occurred overall. CAC, ABI, high-sensitivity CRP, and family history were independently associated with incident CHD …