J Korean Soc Radiol.  2016 Feb;74(2):75-81. 10.3348/jksr.2016.74.2.75.

Relationship between Framingham Risk Score and Coronary Artery Calcium Score in Asymptomatic Korean Individuals

• Heo SY
• Park NH
• Park CS
• Seong SO

• KMID: 2152598
• DOI: http://doi.org/10.3348/jksr.2016.74.2.75

Abstract

PURPOSE
We explored the association between Framingham risk score (FRS) and coronary artery calcium score (CACS) in asymptomatic Korean individuals.
MATERIALS AND METHODS
We retrospectively analyzed 2216 participants who underwent routine health screening and CACS using the 64-slice multidetector computed tomography between January 2010 and June 2014. Relationship between CACS and FRS, and factors associated with discrepancy between CACS and FRS were analyzed.
RESULTS
CACS and FRS were positively correlated (p < 0.0001). However, in 3.7% of participants with low coronary event risk and high CACS, age, male gender, smoker, hypertension, total cholesterol, diabetes mellitus, and body mass index (BMI; > or = 35) were associated with the discrepancy. In the diagnostic prediction model for discrepancy, the receiver operating characteristic curve including factors associated with FRS, diastolic blood pressure (> or = 75 mm Hg), diabetes mellitus, and BMI (> or = 35) showed that the area under the curve was 0.854 (95% confidence interval, 0.819-0.890), indicating good sensitivity.
CONCLUSION
Diabetes mellitus or obesity (BMI > or = 35) compensate for the weakness of FRS and may be potential indicators for application of CACS in asymptomatic Koreans with low coronary event risk.

MeSH Terms

Blood Pressure
Body Mass Index
Calcium*
Cholesterol
Coronary Artery Disease
Coronary Vessels*
Diabetes Mellitus
Humans
Hypertension
Male
Mass Screening
Multidetector Computed Tomography
Obesity
Retrospective Studies
ROC Curve
Vascular Calcification
Calcium
Cholesterol

Figure

• 

  Fig. 1 Scatter plot shows a positive correlation between the coronary artery calcium score and the Framingham risk score in asymptomatic Korean individuals (Spearman's correlation coefficient r = 0.464, p < 0.0001).

• 

  Fig. 2 Receiver operating characteristic curve for the coronary artery calcium score prediction model included factors associated with Framingham risk score (FRS) and additional factors including diastolic blood pressure (≥ 75 mm Hg), diabetes mellitus, and BMI (≥ 35). The area under the curve (AUC) was 0.854 (95% CI, 0.819–0.890), which indicates improved results, as compared to the prediction model including only FRS-associated factors (AUC = 0.838, 95% CI = 0.801–0.874). BMI = body mass index, CI = confidence interval

Reference

1. Sekikawa A, Curb JD, Edmundowicz D, Okamura T, Choo J, Fujiyoshi A, et al. Coronary artery calcification by computed tomography in epidemiologic research and cardiovascular disease prevention. J Epidemiol. 2012; 22:188–198.

2. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001; 285:2486–2497.

3. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–3421.

4. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 2004; 44:720–732.

5. Johnson KM, Dowe DA, Brink JA. Traditional clinical risk assessment tools do not accurately predict coronary atherosclerotic plaque burden: a CT angiography study. AJR Am J Roentgenol. 2009; 192:235–243.

6. Ha EJ, Kim Y, Cheung JY, Shim SS. Coronary artery disease in asymptomatic young adults: its prevalence according to coronary artery disease risk stratification and the CT characteristics. Korean J Radiol. 2010; 11:425–432.

7. Hoshino T, Chow LA, Hsu JJ, Perlowski AA, Abedin M, Tobis J, et al. Mechanical stress analysis of a rigid inclusion in distensible material: a model of atherosclerotic calcification and plaque vulnerability. Am J Physiol Heart Circ Physiol. 2009; 297:H802–H810.

8. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358:1336–1345.

9. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003; 228:826–833.

10. Wong ND, Hsu JC, Detrano RC, Diamond G, Eisenberg H, Gardin JM. Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol. 2000; 86:495–498.

11. LaMonte MJ, FitzGerald SJ, Church TS, Barlow CE, Radford NB, Levine BD, et al. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol. 2005; 162:421–429.

12. Yamamoto H, Kitagawa T, Ohashi N, Utsunomiya H, Kunita E, Oka T, et al. Noncalcified atherosclerotic lesions with vulnerable characteristics detected by coronary CT angiography and future coronary events. J Cardiovasc Comput Tomogr. 2013; 7:192–199.

13. Bild DE, Detrano R, Peterson D, Guerci A, Liu K, Shahar E, et al. Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2005; 111:1313–1320.

14. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006; 113:30–37.

15. Bild DE, Folsom AR, Lowe LP, Sidney S, Kiefe C, Westfall AO, et al. Prevalence and correlates of coronary calcification in black and white young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Arterioscler Thromb Vasc Biol. 2001; 21:852–857.

16. Park HE, Kim MK, Choi SY, Lee W, Shin CS, Cho SH, et al. The prevalence and distribution of coronary artery calcium in asymptomatic Korean population. Int J Cardiovasc Imaging. 2012; 28:1227–1235.

17. Sung J, Lim SJ, Choe Y, Choi YH, Lee MK, Lee SH, et al. Comparison of the coronary calcium score with the estimated coronary risk. Coron Artery Dis. 2008; 19:475–479.