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Providing Evidence for Subclinical CVD in Risk Assessment

Authors:

Michael J. Blaha ,

Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, US
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Joseph Yeboah,

Department of Internal Medicine/Cardiology, Wake Forest University Health Sciences, Winston Salem, NC, US
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Mahmoud Al Rifai,

Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
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Kiang Liu,

Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
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Richard Kronmal,

Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, US
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Philip Greenland

Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
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Abstract

When the MESA (Multi-Ethnic Study of Atherosclerosis) began, the Framingham risk score was the preferred tool for 10-year global coronary heart disease risk assessment; however, the Framingham risk score had limitations including derivation in a homogenous population lacking racial and ethnic diversity and exclusive reliance on traditional risk factors without consideration of most subclinical disease measures. MESA was designed to study the prognostic value of subclinical atherosclerosis and other risk markers in a multiethnic population. In a series of landmark publications, MESA demonstrated that measures of subclinical cardiovascular disease add significant prognostic value to the traditional Framingham risk variables. In head-to-head studies comparing these markers, MESA established that the coronary artery calcium score may be the single best predictor of coronary heart disease risk. Results from MESA have directly influenced recent prevention guidelines including the recommendations on risk assessment and cholesterol-lowering therapy. The MESA study has published its own risk score, which allows for the calculation of 10-year risk of coronary heart disease before and after knowledge of a coronary artery calcium score.

Highlights

  • The MESA (Multi-Ethnic Study of Atherosclerosis) is the first National Heart, Lung, and Blood Institute cohort dedicated to the study of subclinical cardiovascular disease, including its predictors, progression, and influence on outcomes.
  • MESA has demonstrated that coronary artery calcium significantly adds risk predictive value beyond traditional risk factors.
  • MESA has directly influenced recommendations in the new 2013 American College of Cardiology/American Heart Association prevention guidelines, including risk prediction and the treatment of blood cholesterol.
  • MESA recently published the first 10-year risk score incorporating both coronary artery calcium and risk factors.
How to Cite: Blaha MJ, Yeboah J, Al Rifai M, Liu K, Kronmal R, Greenland P. Providing Evidence for Subclinical CVD in Risk Assessment. Global Heart. 2016;11(3):275–85. DOI: http://doi.org/10.1016/j.gheart.2016.08.003
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Published on 01 Sep 2016.
Peer Reviewed

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