Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines

Axel C P Diederichsen, Amir-Abbas Mahabadi, Oke Gerke, Nils Lehmann, Niels P Sand, Susanne Moebus, Jess Lambrechtsen, Hagen Kälsch, Jesper M Jensen, Karl-Heinz Jöckel, Hans Mickley, Raimund Erbel

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Abstract

OBJECTIVES: The European HeartScore has traditionally differentiated between low and high-risk countries. Until 2012 Germany and Denmark were considered to be high-risk countries but have now been defined as low-risk countries. In this survey we aim to address the consequences of this downgrading.

METHODS: A screening of 3932 randomly selected (mean age 56 years, 46% male) individuals from Germany and Denmark free of cardiovascular disease was performed. Traditional risk factors were determined, and the HeartScore was measured using both the low-risk and the high-risk country models. A non-contrast Cardiac-CT scan was performed to detect coronary artery calcification (CAC).

RESULTS: Agreement of HeartScore risk groups with CAC groups was poor, but higher when applying the algorithm for the low-risk compared to the high-risk country model (agreement rate: 77% versus 63%, and weighted Kappa: 0.22 versus 0.15). However, the number of subjects with severe coronary calcification (CAC score ≥400) increased in the low and intermediate HeartScore risk group from 78 to 147 participants (from 2.7 % to 4.2 %, p = 0.001), when estimating the risk based on the algorithm for low-risk countries.

CONCLUSION: As a consequence of the reclassification of Germany and Denmark as low-risk countries more people with severe atherosclerosis will be classified as having a low or intermediate risk of fatal cardiovascular disease.

Original languageEnglish
JournalAtherosclerosis
Volume239
Issue number1
Pages (from-to)143-149
ISSN0021-9150
DOIs
Publication statusPublished - 15. Jan 2015

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Diederichsen, Axel C P ; Mahabadi, Amir-Abbas ; Gerke, Oke ; Lehmann, Nils ; Sand, Niels P ; Moebus, Susanne ; Lambrechtsen, Jess ; Kälsch, Hagen ; Jensen, Jesper M ; Jöckel, Karl-Heinz ; Mickley, Hans ; Erbel, Raimund. / Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines. In: Atherosclerosis. 2015 ; Vol. 239, No. 1. pp. 143-149.
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title = "Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines",
abstract = "OBJECTIVES: The European HeartScore has traditionally differentiated between low and high-risk countries. Until 2012 Germany and Denmark were considered to be high-risk countries but have now been defined as low-risk countries. In this survey we aim to address the consequences of this downgrading.METHODS: A screening of 3932 randomly selected (mean age 56 years, 46{\%} male) individuals from Germany and Denmark free of cardiovascular disease was performed. Traditional risk factors were determined, and the HeartScore was measured using both the low-risk and the high-risk country models. A non-contrast Cardiac-CT scan was performed to detect coronary artery calcification (CAC).RESULTS: Agreement of HeartScore risk groups with CAC groups was poor, but higher when applying the algorithm for the low-risk compared to the high-risk country model (agreement rate: 77{\%} versus 63{\%}, and weighted Kappa: 0.22 versus 0.15). However, the number of subjects with severe coronary calcification (CAC score ≥400) increased in the low and intermediate HeartScore risk group from 78 to 147 participants (from 2.7 {\%} to 4.2 {\%}, p = 0.001), when estimating the risk based on the algorithm for low-risk countries.CONCLUSION: As a consequence of the reclassification of Germany and Denmark as low-risk countries more people with severe atherosclerosis will be classified as having a low or intermediate risk of fatal cardiovascular disease.",
author = "Diederichsen, {Axel C P} and Amir-Abbas Mahabadi and Oke Gerke and Nils Lehmann and Sand, {Niels P} and Susanne Moebus and Jess Lambrechtsen and Hagen K{\"a}lsch and Jensen, {Jesper M} and Karl-Heinz J{\"o}ckel and Hans Mickley and Raimund Erbel",
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Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines. / Diederichsen, Axel C P; Mahabadi, Amir-Abbas; Gerke, Oke; Lehmann, Nils; Sand, Niels P; Moebus, Susanne; Lambrechtsen, Jess; Kälsch, Hagen; Jensen, Jesper M; Jöckel, Karl-Heinz; Mickley, Hans; Erbel, Raimund.

In: Atherosclerosis, Vol. 239, No. 1, 15.01.2015, p. 143-149.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines

AU - Diederichsen, Axel C P

AU - Mahabadi, Amir-Abbas

AU - Gerke, Oke

AU - Lehmann, Nils

AU - Sand, Niels P

AU - Moebus, Susanne

AU - Lambrechtsen, Jess

AU - Kälsch, Hagen

AU - Jensen, Jesper M

AU - Jöckel, Karl-Heinz

AU - Mickley, Hans

AU - Erbel, Raimund

N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PY - 2015/1/15

Y1 - 2015/1/15

N2 - OBJECTIVES: The European HeartScore has traditionally differentiated between low and high-risk countries. Until 2012 Germany and Denmark were considered to be high-risk countries but have now been defined as low-risk countries. In this survey we aim to address the consequences of this downgrading.METHODS: A screening of 3932 randomly selected (mean age 56 years, 46% male) individuals from Germany and Denmark free of cardiovascular disease was performed. Traditional risk factors were determined, and the HeartScore was measured using both the low-risk and the high-risk country models. A non-contrast Cardiac-CT scan was performed to detect coronary artery calcification (CAC).RESULTS: Agreement of HeartScore risk groups with CAC groups was poor, but higher when applying the algorithm for the low-risk compared to the high-risk country model (agreement rate: 77% versus 63%, and weighted Kappa: 0.22 versus 0.15). However, the number of subjects with severe coronary calcification (CAC score ≥400) increased in the low and intermediate HeartScore risk group from 78 to 147 participants (from 2.7 % to 4.2 %, p = 0.001), when estimating the risk based on the algorithm for low-risk countries.CONCLUSION: As a consequence of the reclassification of Germany and Denmark as low-risk countries more people with severe atherosclerosis will be classified as having a low or intermediate risk of fatal cardiovascular disease.

AB - OBJECTIVES: The European HeartScore has traditionally differentiated between low and high-risk countries. Until 2012 Germany and Denmark were considered to be high-risk countries but have now been defined as low-risk countries. In this survey we aim to address the consequences of this downgrading.METHODS: A screening of 3932 randomly selected (mean age 56 years, 46% male) individuals from Germany and Denmark free of cardiovascular disease was performed. Traditional risk factors were determined, and the HeartScore was measured using both the low-risk and the high-risk country models. A non-contrast Cardiac-CT scan was performed to detect coronary artery calcification (CAC).RESULTS: Agreement of HeartScore risk groups with CAC groups was poor, but higher when applying the algorithm for the low-risk compared to the high-risk country model (agreement rate: 77% versus 63%, and weighted Kappa: 0.22 versus 0.15). However, the number of subjects with severe coronary calcification (CAC score ≥400) increased in the low and intermediate HeartScore risk group from 78 to 147 participants (from 2.7 % to 4.2 %, p = 0.001), when estimating the risk based on the algorithm for low-risk countries.CONCLUSION: As a consequence of the reclassification of Germany and Denmark as low-risk countries more people with severe atherosclerosis will be classified as having a low or intermediate risk of fatal cardiovascular disease.

U2 - 10.1016/j.atherosclerosis.2015.01.005

DO - 10.1016/j.atherosclerosis.2015.01.005

M3 - Journal article

C2 - 25602856

VL - 239

SP - 143

EP - 149

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

IS - 1

ER -