Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic Cohort
Authors: Andrew P. DeFilippis, Rebekah Young, Michael J. Blaha
Journal: Annals of Internal Medicine (2015)

Letters7 July 2015Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic CohortAndrew P. DeFilippis, MD, MSc, Rebekah Young, PhD, and Michael J. Blaha, MD, MPHAndrew P. DeFilippis, MD, MScFrom University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; and Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.Search for more papers by this author, Rebekah Young, PhDFrom University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; and Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.Search for more papers by this author, and Michael J. Blaha, MD, MPHFrom University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; and Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5105-2 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The study cited by Dr. Goff and colleagues (1) shows an association between CAC score and medication use, not an association with decreased events. As the authors acknowledge in the guideline (with the tepid grade IIb recommendation for CAC testing), evidence for a direct effect of CAC scoring on hard outcomes is limited (2). For CAC scoring to explain the overestimation of the risk for ASCVD, the reporting of CAC scores in MESA would have had to prevent almost one half of all ASCVD events predicted by the AHA-ACC-ASCVD risk score.The purpose of our sensitivity analysis was ...References1. Nasir K, McClelland RL, Blumenthal RS, Goff DC, Hoffmann U, Psaty BM, et al. Coronary artery calcium in relation to initiation and continuation of cardiovascular preventive medications: the Multi-Ethnic Study of Atherosclerosis (MESA). Circ Cardiovasc Qual Outcomes. 2010;3:228-35. [PMID: 20371760] doi:10.1161/CIRCOUTCOMES.109.893396 CrossrefMedlineGoogle Scholar2. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49-73. [PMID: 24222018] doi:10.1161/01.cir.0000437741.48606.98 CrossrefMedlineGoogle Scholar3. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2007;49:69-75. [PMID: 17159087] CrossrefMedlineGoogle Scholar4. Qiuping G, Paulose-Ram R, Burt VL, Kit BK. Prescription cholesterol-lowering medication use in adults aged 40 and over: United States, 2003-2012. National Center for Health Statistics Data Brief no. 177. Hyattsville, Maryland: U.S. Department of Health and Human Services; 2014. Accessed at www.cdc.gov/nchs/data/databriefs/db177.htm#ref10 on 5 April 2015. Google Scholar5. Kavousi M, Leening MJ, Nanchen D, Greenland P, Graham IM, Steyerberg EW, et al. Comparison of application of the ACC/AHA guidelines, Adult Treatment Panel III guidelines, and European Society of Cardiology guidelines for cardiovascular disease prevention in a European cohort. JAMA. 2014;311:1416-23. [PMID: 24681960] doi:10.1001/jama.2014.2632 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Andrew P. DeFilippis, MD, MSc; Rebekah Young, PhD; Michael J. Blaha, MD, MPHAffiliations: From University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; and Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1281. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAn Analysis of Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic Cohort Andrew P. DeFilippis , Rebekah Young , Christopher J. Carrubba , John W. McEvoy , Matthew J. Budoff , Roger S. Blumenthal , Richard A. Kronmal , Robyn L. McClelland , Khurram Nasir , and Michael J. Blaha Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic Cohort David C. Goff Jr. , Ralph B. D'Agostino Sr. , Michael Pencina , and Donald M. 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