Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) Coronary Calcium Atherosclerotic Cardiovascular Disease Risk Calculator

Circulation. 2018 Oct 23;138(17):1819-1827. doi: 10.1161/CIRCULATIONAHA.118.033505.

Abstract

Background: Coronary artery calcium (CAC) is a powerful novel risk indicator for atherosclerotic cardiovascular disease (ASCVD). Currently, there is no available ASCVD risk prediction tool that integrates traditional risk factors and CAC.

Methods: To develop a CAC ASCVD risk tool for younger individuals in the general population, subjects aged 40 to 65 without prior cardiovascular disease from 3 population-based cohorts were included. Cox proportional hazards models were developed incorporating age, sex, systolic blood pressure, total and high-density lipoprotein cholesterol, smoking, diabetes mellitus, hypertension treatment, family history of myocardial infarction, high-sensitivity C-reactive protein, and CAC scores (Astro-CHARM model [Astronaut Cardiovascular Health and Risk Modification]) as dependent variables and ASCVD (nonfatal/fatal myocardial infarction or stroke) as the outcome. Model performance was assessed internally, and validated externally in a fourth cohort.

Results: The derivation study comprised 7382 individuals with a mean age 51 years, 45% women, and 55% nonwhite. The median CAC was 0 (25th, 75th [0,9]), and 304 ASCVD events occurred in a median 10.9 years of follow-up. The c-statistic was 0.784 for the risk factor model, and 0.817 for Astro-CHARM ( P<0.0001). In comparison with the risk factor model, the Astro-CHARM model resulted in integrated discrimination improvement (0.0252), and net reclassification improvement (0.121; P<0.0001), as well. The Astro-CHARM model demonstrated good discrimination (c=0.78) and calibration (Nam-D'Agostino χ2, 13.2; P=0.16) in the validation cohort (n=2057; 55 events). A mobile application and web-based tool were developed to facilitate clinical application of this tool ( www.AstroCHARM.org ).

Conclusion: The Astro-CHARM tool is the first integrated ASCVD risk calculator to incorporate risk factors, including high-sensitivity C-reactive protein and family history, and CAC data. It improves risk prediction in comparison with traditional risk factor equations and could be useful in risk-based decision making for cardiovascular disease prevention in the middle-aged general population.

Keywords: calcification of joints and arteries; coronary vessels; risk assessment.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / physiopathology
  • Decision Support Techniques*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / mortality
  • Dyslipidemias / blood
  • Dyslipidemias / diagnosis
  • Dyslipidemias / mortality
  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Inflammation Mediators / blood
  • Internet
  • Lipids / blood
  • Male
  • Middle Aged
  • Mobile Applications
  • Myocardial Infarction / blood
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / mortality
  • Stroke / blood
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / physiopathology
  • Time Factors
  • Vascular Calcification / blood
  • Vascular Calcification / diagnosis*
  • Vascular Calcification / mortality
  • Vascular Calcification / physiopathology

Substances

  • Biomarkers
  • Inflammation Mediators
  • Lipids
  • C-Reactive Protein