ArticleJournal of the American College of Cardiology2015
10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study).
Article in Journal of the American College of Cardiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05392491 (The Brazilian Coronary Disease Cohort), which is not on this map. Cited by 337 papers, 5 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Brazilian Coronary Disease Cohort
Who cites it
337 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- A systematic review focusing on how medical researchers report variables in risk scores or models to predict prognosis of patients after percutaneous coronary intervention.BMC cardiovascular disorders · 2026Pooled it
- Pooled it
- Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies.Arteriosclerosis, thrombosis, and vascular biology · 2024Pooled it
- A Systematic Review and Meta-Analysis of Advanced Biomarkers for Predicting Incident Cardiovascular Disease among Asymptomatic Middle-Aged Adults.International journal of molecular sciences · 2022Pooled it
- American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022Guideline
- Coronary Artery Calcium and Cognitive Decline in the Diabetes Prevention Program Outcomes Study.Journal of the American Heart Association · 2023Trial
- Influence of rivaroxaban compared to vitamin K antagonist treatment upon development of cardiovascular calcification in patients with atrial fibrillation and/or pulmonary embolism.Clinical cardiology · 2022Trial
- Real-world impact of coronary artery calcium scoring on primary prevention management in a community cardiology practice.American heart journal plus : cardiology research and practice · 2026Article
- Examining the relationship between anthropometric and body composition measures with coronary heart disease events: the multi-ethnic study of atherosclerosis.European journal of preventive cardiology · 2026Article
- Use of a polygenic risk score to enhance early detection of coronary atherosclerosis.American journal of preventive cardiology · 2026Article
- Blood-Based DNA Methylation Models Improve Short-term Cardiovascular Risk Stratification in Individuals With Type 2 Diabetes.Diabetes care · 2026Article
- Ischemic Risk in Patients with Zero Coronary Artery Calcium Undergoing Stress PET/CT Testing.Journal of clinical medicine · 2026Article
- Inherited risk of coronary artery disease: redefining care with imaging and genetics.Nature reviews. Cardiology · 2026Review
- Uric acid and subclinical atherosclerosis: distinct associations across coronary and carotid arteries.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Contrastive Machine Learning to Quantify Hypertensive Multiorgan Damage and Identify New Disease Phenotypes: A Multinational Multimodal Study.Circulation · 2026Article
- Interaction of a genetic sum score of risk alleles associated with coronary artery disease by physical activity in the Heinz Nixdorf Recall study.BMC cardiovascular disorders · 2026Article
- Masters Athletes With Abnormal Cardiovascular Findings: A Clinical Consensus Statement of the European Association of Preventive Cardiology of the ESC and the American College of Cardiology.Journal of the American College of Cardiology · 2026Article
- Exercise-Induced Coronary Remodeling and the Atherosclerotic Paradox in Endurance Athletes: Toward a Unified Mechanobiological Framework.Journal of functional morphology and kinesiology · 2026Review
- Circulating osteoprotegerin and progression of coronary artery calcification in patients with chronic kidney disease: the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD).Kidney research and clinical practice · 2026Article
- Masters athletes with abnormal cardiovascular findings: a clinical consensus statement of the European Association of Preventive Cardiology of the ESC and the American College of Cardiology.European heart journal · 2026Article
277 more citing papers are in PubMed but not listed here.
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Authors and funding
20 authors.
Funding
Abstract
backgroundSeveral studies have demonstrated the tremendous potential of using coronary artery calcium (CAC) in addition to traditional risk factors for coronary heart disease (CHD) risk prediction. However, to date, no risk score incorporating CAC has been developed.
objectivesThe goal of this study was to derive and validate a novel risk score to estimate 10-year CHD risk using CAC and traditional risk factors.
methodsAlgorithm development was conducted in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective community-based cohort study of 6,814 participants age 45 to 84 years, who were free of clinical heart disease at baseline and followed for 10 years. MESA is sex balanced and included 39% non-Hispanic whites, 12% Chinese Americans, 28% African Americans, and 22% Hispanic Americans. External validation was conducted in the HNR (Heinz Nixdorf Recall Study) and the DHS (Dallas Heart Study).
resultsInclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 vs. 0.75; p < 0.0001). External validation in both the HNR and DHS studies provided evidence of very good discrimination and calibration. Harrell's C-statistic was 0.779 in HNR and 0.816 in DHS. Additionally, the difference in estimated 10-year risk between events and nonevents was approximately 8% to 9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within one-half of a percent of the observed event rate.
conclusionsAn accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. The MESA risk score, which is available online on the MESA web site for easy use, can be used to aid clinicians when communicating risk to patients and when determining risk-based treatment strategies.
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Registered trials
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