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Cardiovascular Risk Assessment (10-year, MESA 2015, with or without CAC score) and Optimization

 

Input
 

Race	Black or African American (1)
	Chinese American (2)
	Hispanic (3)
	Non-Hispanic white (4)
Sex	Female (0)
	Male (1)
Age		mo yr
Total cholesterol		mg/dL mmol/L
HDL cholesterol		mg/dL mmol/L
Systolic blood pressure		Pascal cmH2O mmHg torr
On hypertension medication	No (0)
	Yes (1)
On lipid-lowering medication	No (0)
	Yes (1)
Diabetes	No (0)
	Yes (1)
Smoker	No (0)
	Yes (1)
Family history of MI	No (0)
	Yes (1)
CAC		Agatston units

 
Results
 
Important: Inputs must be complete to perform calculation.

 

Terms
10-year risk		% fraction percent rate ratio
Terms CAC
10-year risk CAC		% fraction percent rate ratio
Decimal Precision   0 1 2 3

 

    Difficulty:   Easy Difficulty:   Medium Difficulty:   Hard

 

 

 

Notes

• MESA: Multi-Ethnic Study of Atherosclerosis; CAC: coronary artery calcification; HDL: high-density lipoprotein; MI: myocardial infarction; ASCVD: atherosclerotic cardiovascular disease; CHD: coronary heart disease.
• This calculator helps predict the 10-year risk of the following ASCVD events:
  • CHD death
  • Nonfatal MI
  • Resuscitated cardiac arrest
  • Coronary revascularization in patient with angina
• When a CAC score is known, a second 10-year risk calculation is done using independent hazard ratios associated with CAC scores.
• Optimization limits include: Total Cholesterol ≥100 mg/dL with a Total Cholesterol to HDL Cholesterol ratio ≥2. Systolic Blood Pressure must be ≥95 mmHg.
• Easy optimizations include:
   
  1) Decrease total cholesterol 10%  
  2) Increase HDL cholesterol 10%  
  3) Decrease systolic blood pressure 10%
• Medium intensity optimizations include:
   
  1) Decrease total cholesterol 20%  
  2) Increase HDL cholesterol 20%  
  3) Decrease systolic blood pressure 20%  
  4) Discontinue blood pressure medication  
  5) Quit smoking
• Hard optimizations include:
   
  1) Decrease total cholesterol 30%  
  2) Increase HDL cholesterol 30%  
  3) Decrease systolic blood pressure 30%

 
Equations used
 

Terms = (Age * 0.0455) + (Sex * 0.7496) + ((Race == 1?1:0) * -0.2111) + ((Race == 2?1:0) * -0.5055) + ((Race == 3?1:0) * -0.19) + (Diabetes * 0.5168) + (Smoker * 0.4732) + (Totalcholesterol * 0.0053) - (HDLcholesterol * 0.0140) + (On lipid-lowering medication * 0.2473) + (Systolic blood pressure * 0.0085) + (On hypertension medication * 0.3381) + (Family history of MI * 0.4522)

10-year risk = 100 * (1 - 0.99963e(Terms))

Terms CAC = (Age * 0.0172) + (Sex * 0.4079) + ((Race == 1?1:0) * 0.0353) + ((Race == 2?1:0) * -0.3475) + ((Race == 3?1:0) * -0.0222) + (Diabetes * 0.3892) + (Smoker * 0.3717) + (Totalcholesterol * 0.0043) - (HDLcholesterol * 0.0114) + (On lipid-lowering medication * 0.1206) + (Systolic blood pressure * 0.0066) + (On hypertension medication * 0.2278) + (Family history of MI * 0.3239) + (ln(CAC + 1) * 0.2743)

10-year risk CAC = 100 * (1 - 0.99833e(Terms CAC))

 

 

Calculation Details and Variables

• Equation parameters such as Race, have two or more discrete values that may be used in the calculation. The numbers in the parentheses, e.g. (1), represent the values that will be used.

 

References

1. Smith DA. ACP Journal Club. In adults without CVD, the MESA score, including coronary artery calcium, predicted 10-y risk for CHD events. Ann Intern Med. 2016 Mar 15;164(6):JC35. PubMed ID: 26974735
2. McClelland RL, Jorgensen NW, Budoff M, et al. 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). J Am Coll Cardiol. 2015 Oct 13;66(15):1643-53. PubMed ID: 26449133

 

Associated Medical Subject Headings [MeSH]
 

80 and over, Aged, Atherosclerosis, Calcinosis, Coronary Angiography, Coronary Artery Disease, Coronary Vessels, Ethnic Groups, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Risk Assessment, Risk Factors, Tomography, X-Ray Computed

 

Associated Logical Observation Identifiers Names and Codes [LOINC]
 

Parameter	LOINC's and Suggested Units
Age	21612-7 : yr      21612-7 : yr      21612-7 : years      30525-0 : Years old      30525-0 : yr      30525-0 : years
Total Cholesterol	2093-3 : mg/dL      14647-2 : mmol/L
HDL Cholesterol	2085-9 : mg/dL      14646-4 : mmol/L
Systolic Blood Pressure	8480-6 : mmHg

 
This material contains content from LOINC® (http://loinc.org). The LOINC table, LOINC codes, and LOINC panels and forms file are copyright © 1995-2014, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and available at no cost under the license at http://loinc.org/terms-of-use.