Predicting Subclinical Atherosclerosis in Low-RiskIndividuals

He Ma dio Sa Ma III De is Un gra Br No Fe thi Ma BACKGROUND The ideal cardiovascular health score (ICHS) is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]) score (FBS), are also available. OBJECTIVES The purpose of this study was to compare the effectiveness of ICHS and FBS in predicting the presence and extent of subclinical atherosclerosis. METHODS A total of 3,983 participants 40 to 54 years of age were enrolled in the PESA (Progression of Early Subclinical Atherosclerosis) cohort. Subclinical atherosclerosis was measured in right and left carotids, abdominal aorta, right and left iliofemoral arteries, and coronary arteries. Subjects were classified as having poor, intermediate, or ideal cardiovascular health based on the number of favorable ICHS or FBS. RESULTS With poor ICHS and FBS as references, individuals with ideal ICHS and FBS showed lower adjusted odds of having atherosclerotic plaques (ICHS odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.31 to 0.55 vs. FBS OR: 0.49; 95% CI: 0.36 to 0.66), coronary artery calcium (CACS) $1 (CACS OR: 0.41; 95% CI: 0.28 to 0.60 vs. CACS OR: 0.53; 95% CI: 0.38 to 0.74), higher number of affected territories (OR: 0.32; 95% CI: 0.26 to 0.41 vs. OR: 0.39; 95% CI: 0.31 to 0.50), and higher CACS level (OR: 0.40; 95% CI: 0.28 to 0.58 vs. OR: 0.52; 95% CI: 0.38 to 0.72). Similar levels of significantly discriminating accuracy were found for ICHS and FBS with respect to the presence of plaques (C-statistic: 0.694; 95% CI: 0.678 to 0.711 vs. 0.692; 95% CI: 0.676 to 0.709, respectively) and for CACS $1 (C-statistic: 0.782; 95% CI: 0.765 to 0.800 vs. 0.780; 95% CI: 0.762 to 0.798, respectively). CONCLUSIONS Both scores predict the presence and extent of subclinical atherosclerosis with similar accuracy, highlighting the value of the FBS as a simpler and more affordable score for evaluating the risk of subclinical disease. (J Am Coll Cardiol 2017;70:2463–73) © 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an openaccess article under theCCBY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/). alth Research, Translational Research Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain; Banco de Santander, drid, Spain; Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación iþ12, Carlogy Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Cardiología, Instituto de Investigación nitaria (IIS)-Fundación Jiménez Díaz Hospital, Madrid, Spain; and the Facultad de Medicina, Universidad Complutense de drid, Madrid, Spain. The PESA study was co-funded by Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC) and Banco Santander. Funding was also provided by Institute of Health Carlos III (PI15/02019) and European Regional velopment Fund. CNIC is supported by the Ministry of Economy, Industry and Competitiveness and Pro CNIC Foundation; and a Severo Ochoa Center of Excellence (SEV-2015-0505). This work is part of a project that received funding from the European ionHorizon 2020 research and innovation programunderMarie Skłodowska-Curie grant 707642 andAmericanHeart Association nt 14SFRN20490315. Dr. Bueno has received research funding from Instituto de Salud Carlos III (PIE16/00021), AstraZeneca, istol-Myers Squibb, Janssen, and Novartis; is a consultant for Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, and vartis; and has received speakers fees and travel and attendance support from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, rrer, Novartis, Servier, and Medscape. All other authors have reported that they have no relationships relevant to the contents of s paper to disclose. Matthew Budoff, MD, served as Guest Editor for this paper. nuscript received July 17, 2017; revised manuscript received September 8, 2017, accepted September 11, 2017. J A C C V O L . 7 0 , N O . 2 0 , 2 0 1 7 Fernández-Alvira et al. N O V E M B E R 1 4 / 2 1 , 2 0 1 7 : 2 4 6 3 – 7 3 Ideal Cardiovascular Health and Atherosclerosis 2465 AB BR E V I A T I O N S