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The mediation of coronary calcification in the association between risk scores and cardiac troponin T elevation in healthy adults: Is atherosclerosis a good prognostic precursor of coronary disease?

Lazzarino, AI; Hamer, M; Carvalho, L; Gaze, D; Collinson, P; Steptoe, A (2015) The mediation of coronary calcification in the association between risk scores and cardiac troponin T elevation in healthy adults: Is atherosclerosis a good prognostic precursor of coronary disease? Prev Med, 77. pp. 150-154. ISSN 1096-0260 https://doi.org/10.1016/j.ypmed.2015.05.025
SGUL Authors: Collinson, Paul

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Abstract

BACKGROUND: Conventional cardiac risk scores may not be completely accurate in predicting acute events because they only include factors associated with atherosclerosis, considered as the fundamental precursor of cardiovascular disease. In UK in 2006-2008 (Whitehall II study) we tested the ability of several risk scores to identify individuals with cardiac cell damage and assessed to what extent their estimates were mediated by the presence of atherosclerosis. METHODS: 430 disease-free, low-risk participants were tested for high-sensitivity cardiac troponin-T (HS-CTnT) and for coronary calcification using electron-beam, dual-source, computed tomography (CAC). We analysed the data cross-sectionally using ROC curves and mediation tests. RESULTS: When the risk scores were ranked according to the magnitude of ROC areas for HS-CTnT prediction, a score based only on age and gender came first (ROC area=0.79), followed by Q-Risk2 (0.76), Framingham (0.70), Joint-British-Societies (0.69) and Assign (0.68). However, when the scores were ranked according to the extent of mediation by CAC (proportion of association mediated), their order was essentially reversed (age&gender=6.8%, Q-Risk2=9.7%, Framingham=16.9%, JBS=17.8%, Assign=17.7%). Therefore, the more accurate a score is in predicting detectable HS-CTnT, the less it is mediated by CAC; i.e. the more able a score is in capturing atherosclerosis the less it is able to predict cardiac damage. The P for trend was 0.009. CONCLUSIONS: The dynamics through which cardiac cell damage is caused cannot be explained by 'classic' heart disease risk factors alone. Further research is needed to identify precursors of heart disease other than atherosclerosis.

Item Type: Article
Additional Information: © 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Acute coronary syndrome, Aetiology, Coronary artery disease, Physiopathology, Risk assessment, Risk factors, Routine Diagnostic tests, Tomography, Troponin T, X-ray computed, Age Factors, Aged, Atherosclerosis, Calcinosis, Cardiovascular Diseases, Coronary Artery Disease, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Prognosis, Risk Assessment, Sex Factors, Tomography, X-Ray Computed, Troponin T, Humans, Cardiovascular Diseases, Calcinosis, Troponin T, Tomography, X-Ray Computed, Prognosis, Risk Assessment, Cross-Sectional Studies, Age Factors, Sex Factors, Aged, Middle Aged, Female, Male, Atherosclerosis, Coronary Artery Disease, Acute coronary syndrome, Troponin T, Coronary artery disease, Risk factors, Risk assessment, Tomography, X-ray computed, Routine Diagnostic tests, Physiopathology, Aetiology, Public Health, 1106 Human Movement And Sports Science, 1117 Public Health And Health Services, 1302 Curriculum And Pedagogy
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: Prev Med
ISSN: 1096-0260
Language: eng
Dates:
DateEvent
August 2015Published
4 June 2015Published Online
30 May 2015Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
MR/K013351/1Medical Research CouncilUNSPECIFIED
RG/10/005/28296British Heart FoundationUNSPECIFIED
UNSPECIFIEDBritish Heart FoundationUNSPECIFIED
PubMed ID: 26051205
Web of Science ID: WOS:000358391600022
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108958
Publisher's version: https://doi.org/10.1016/j.ypmed.2015.05.025

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