Table 2.
Incremental Utility of Risk Enhancers and CAC Score Over the Pooled Cohort Equation*
| C Statistic | Integrated Discrimination | Net Reclassification | ||||
|---|---|---|---|---|---|---|
| PCE Alone | PCE+Risk Enhancer | P Value for Improvement | IDI (P Value) | NRI Across 7.5%–20% Cut Points (P Value) | Category‐Free NRI (P Value) | |
| Triglyceride ≥175 mg/dL | 0.789 | 0.789 | 0.27 | −0.0001 (0.89) | 0.005 (0.06) | 0.024 (0.23) |
| LDL‐C≥160 mg/dL | 0.789 | 0.789 | 0.51 | −0.0002 (0.90) | 0.002 (0.41) | −0.013 (0.21) |
| Non–HDL‐C≥190 mg/dL | 0.789 | 0.789 | 0.52 | −0.0001 (0.31) | −0.001 (0.71) | −0.026 (0.34) |
| Metabolic syndrome | 0.789 | 0.789 | 0.27 | −0.0001 (21) | 0.006 (0.23) | 0.116 (0.19) |
| CKD | 0.789 | 0.790 | 0.30 | 0.002 (0.04) | 0.002 (0.57) | −0.153 (0.001) |
| ABI ≤0.9 | 0.789 | 0.790 | 0.22 | 0.003 (0.03) | 0.005 (0.35) | −0.374 (0.001) |
| hs‐CRP ≥2 mg/dL | 0.796 | 0.796 | 0.93 | 0.0001 (0.43) | −0.004 (0.61) | 0.181 (0.001) |
| Lp(a) ≥50 mg/dL | 0.796 | 0.798 | 0.05 | 0.0001 (0.82) | 0.024 (0.01) | 0.058 (0.10) |
| apoB ≥130 mg/dL | 0.773 | 0.775 | 0.05 | 0.0001 (0.50) | 0.014 (0.04) | 0.156 (0.07) |
| Family history of premature CVD | 0.773 | 0.776 | 0.05 | −0.0001 (0.76) | −0.004 (0.41) | 0.024 (0.79) |
| No. of risk enhancers ≥3* | 0.762 | 0.766 | 0.10 | 0.010 (0.005) | 0.041 (0.007) | 0.120 (0.01) |
| CAC >0 Agatston units | 0.762 | 0.774 | 0.01 | 0.010 (<0.001) | 0.073 (0.005) | 0.585 (<0.001) |
ABI indicates ankle‐brachial index; apoB, apolipoprotein B; CAC, coronary artery calcium; CKD, chronic kidney disease; CVD, cardiovascular disease; HDL‐C, high‐density lipoprotein cholesterol; hs‐CRP, high‐sensitivity C‐reactive protein; IDI, integrated discrimination index; LDL‐C, low‐density lipoprotein cholesterol; Lp(a), lipoprotein (a); NRI, net reclassification index; and PCE, pooled cohort equation.
Model calibration was optimum (P≥0.35) across all models (not shown in the table).
The aggregate risk enhancer variable represents the number of risk enhancers present for each participant. Only the 6 risk enhancers that demonstrated significant predictive ability (ie, hs‐CRP, apoB, CKD, family history of premature CVD, Lp(a), and ABI) were included in this aggregate variable.