The Added Value of Coronary Calcium Score in Predicting Cardiovascular Events in Familial Hypercholesterolemia
2021
Gallo, Antonio | Pérez de Isla, Leopoldo | Charrière, Sybil | Vimont, Alexandre | Alonso, Rodrigo | Muñiz-Grijalvo, Ovidio | Díaz-Díaz, José | Zambón, Daniel | Moulin, Philippe | Bruckert, Eric | Mata, Pedro | Béliard, Sophie | Angoulvant, Denis | Boccara, Franck | Cariou, Bertrand | Carreau, Valérie | Carrie, Alain | Charrieres, Sybil | Cottin, Yves | Di Filippo, Mathilde | Ducluzeau, Pierre-Henri | Dulong, Sonia | Durlach, Vincent | Farnier, Michel | Ferrari, Emile | Ferrieres, Dorota | Ferrieres, Jean | Giral, Philippe | Gonbert, Sophie | Hankard, Regis | Inamo, Jocelyn | Kalmykova, Olga | Krempf, Michel | Lemale, Julie | Paillard, François | Peretti, Noel | Perrin, Agnes | Pradignac, Alain | Rabes, Jean Pierre | Rigalleau, Vincent | Schiele, François | Tounian, Patrick | Valero, René | Verges, Bruno | Yelnik, Cecile | Ziegler, Olivier | Aguado, Rocío | Álvarez-Baños, Ma Pilar | Argüeso, Rosa | Arrieta, Francisco | Barba, Miguel Ángel | Casañas, Marta | Cepeda, José María | de Andrés, Raimundo | Díaz-Soto, Gonzalo | Díaz-Diaz, Jose Luis | Dieguez, Marta | Faedo, Ceferino | Fuentes, Francisco | Garrido, Juan | González, Aurora | González-Bustos, Pablo | Mañas, Ma Dolores | Mauri, Marta | Mediavilla, Juan Diego | Michán, Alfredo | Miramontes, Pablo | Muñiz, Ovidio | Pérez, Leire | de Isla, Leopoldo Perez | Pintó, Xavier | Romero, Manuel | Rubio, Patricia | Sánchez Muñoz-Torrero, Juan | Vidal-Pardo, Jose | Sultan, Ariane | CHU Pitié-Salpêtrière [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) | Laboratoire d'Imagerie Biomédicale [Paris] (LIB) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS) | Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN) ; CHU Pitié-Salpêtrière [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) | Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain] (IdISSC) | Fundación Hipercolesterolemia Familiar (FHF) | Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN) ; Université Claude Bernard Lyon 1 (UCBL) ; Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | Public Health Expertise [Paris, France] | Hospital Universitario Virgen del Rocío [Sevilla] | Hospital Abente y Lago [A Coruña] | Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) ; Universitat de Barcelona (UB) | Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN) ; Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | Hôpital de la Conception [CHU - APHM] (LA CONCEPTION) | Equipe AGING (CERPOP) ; Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP) ; Université Toulouse III - Paul Sabatier (UT3) ; Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3) ; Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS) | Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) | ANR-16-RHUS-0007,CHOPIN,CHOPIN(2016)
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Show more [+] Less [-]English. Objectives: This study aimed at investigating the additional contribution of coronary artery calcium (CAC) score to SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) risk equation (SAFEHEART-RE) for cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH).Background: Common cardiovascular risk equations are imprecise for HeFH. Because of the high phenotype variability of HeFH, CAC score could help to better stratify the risk of atherosclerotic cardiovascular disease (ASCVD).Methods: REFERCHOL (French Registry of Familial Hypercholesterolemia) and SAFEHEART are 2 ongoing national registries on HeFH. We analyzed data from primary prevention HeFH patients undergoing CAC quantification. We used probability-weighted Cox proportional hazards models to estimate HRs. Area under the receiver-operating characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare the incremental contribution of CAC score when added to the SAFEHEART-RE for ASCVD prediction. ASCVD was defined as coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, resuscitated sudden death, and cardiovascular death.Results: We included 1,624 patients (mean age: 48.5 ± 12.8 years; men: 45.7%) from both registries. After a median follow-up of 2.7 years (interquartile range: 0.4-5.0 years), ASCVD occurred in 81 subjects. The presence of a CAC score of >100 was associated with an HR of 32.05 (95% CI: 10.08-101.94) of developing ASCVD as compared to a CAC score of 0. Receiving-operating curve analysis showed a good performance of CAC score alone in ASCVD prediction (AUC: 0.860 [95% CI: 0.853-0.869]). The addition of log(CAC + 1) to SAFEHEART-RE resulted in a significantly improved prediction of ASCVD (AUC: 0.884 [95% CI: 0.871-0.894] for SAFEHEART-RE + log(CAC + 1) vs AUC: 0.793 [95% CI: 0.779-0.818] for SAFEHEART-RE; P < 0.001). These results were confirmed also when considering only hard cardiovascular endpoints. The addition of CAC score was associated with an estimated overall net reclassification improvement of 45.4%.Conclusions: CAC score proved its use in improving cardiovascular risk stratification and ASCVD prediction in statin-treated HeFH.
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