Novel Multimodality Testing Strategy Improves CVD Risk Assessment

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A mutlimodal strategy combines 5 separate tests to significantly improve CVD and ASVCD risk assessment.
A mutlimodal strategy combines 5 separate tests to significantly improve CVD and ASVCD risk assessment.

For adults without known cardiovascular disease, a multimodality strategy combining 5 tests significantly improved global cardiovascular disease (CVD) and atherosclerotic cardiovascular disease (ASCVD) risk assessment, according to a new study published in Circulation.

Currently, assessing risk CVD among adults without known CVD is "limited by suboptimal performance and a narrow focus on only ASCVD," explained James de Lemos, MD, from UT Southwestern Medical Center. Dr de Lemos and colleagues posit that combined results from 5 tests would better predict the risk of CVD vs. the standard strategies that focus on blood pressure, cholesterol, diabetes, and smoking history.

The 5 tests include a 12-lead EKG, a coronary calcium scan, C-reactive protein test, NT-proBNP test, and a high-sensitivity troponin T test.

Researchers evaluated patients from the Multi-Ethnic Study of Atherosclerosis (MESA; n=6,621) and Dallas Heart Study (n=2,202) who were free from CVD and underwent measurement of left ventricular hypertrophy by the 5 tests. The relationship between the test results and global composite CVD outcome (CVD death, MI, stroke, coronary or peripheral revascularization, incident heart failure or atrial fibrillation) and ASCVD (fatal or nonfatal MI or stroke) were analyzed for >10 years of follow-up.

Study results found that each test result was associated with global composite CVD events in MESA after adjusting for components in the base model and other results (P <.05). There was an improvement in the c-statistic after the 5 tests were added to the base model (0.74-0.79; =.001), as well as in significant integrated discrimination (.07; 95% CI, 0.06-0.08; <.001) and net reclassification (0.47; 95% CI, 0.38-0.56; =.003). 

Global CVD risk was higher among patients with a score of 1 (adjusted HR: 1.9; 95% CI, 1.4-2.6), a score of 2 (HR: 3.2; 95% CI, 2.3-4.4), a score of 3 (HR: 4.7; 95% CI, 3.4-6.5), and a score of ≥4 (HR: 7.5; 95% CI, 5.2-10.6), when compared to those with a score of 0; the score indicated the number of abnormal tests. These findings were similar for the ASCVD outcome. 

Overall, the combined 5 tests allowed a broader risk prediction to include the likelihood of heart failure and atrial fibrillation, and also showed to be a better predictor of heart attack and stroke vs currently recommended strategies. Dr Amit Khera added, "These 5 tests have all stood on their own already. And they each tell us something different about potential heart problems — they're additive. As a result, we are getting a good look at global cardiovascular disease risk."

Reference

de Lemos JA, Ayers CR, Levine BD, et al. A multimodality strategy for cardiovascular risk assessment: performance in two population-based cohorts [published online March 30, 2017]. Circulation. doi: 10.1161/CIRCULATIONAHA.117.027272

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