Combined Framingham risk score and coronary artery calcium score predict subclinical coronary plaque assessed by coronary computed tomography angiogram in asymptomatic Taiwanese population

Background:We sought to determine the predictive value of the combined traditional Framingham risk score (FRS) and coronary artery calcium score (CACS) for subclinical coronary plaque detected by computed tomography coronary angiogram (CTCA) in asymptomatic subjects. Method: We evaluated 167 asymptomatic Taiwanese subjects (mean age, 57 - 11.2 years), who underwent CTCA as part of a health evaluation.We examined the associations between FRS, CACS, serum biomarkers, and coronary plaque assessed by CTCA. Results: Out of 167 subjects in the study, 95 had coronary artery atheroma. Of those possible predictors for coronary atherosclerosis, both FRS and CACS were independent predictors for the presence of coronary plaque [relative risk (RR): 1.29, 95% confidence interval (CI): 1.07-1.54, p = 0.006 and RR: 1.42, 95% CI: 1.16-1.75, p = 0.001, respectively]. Receiver operating characteristics curve analysis revealed that CACS and FRS were indicators of the presence of coronary plaque. The area under the curve for FRS and CACS was 0.729 and 0.889, respectively (p <0.001). Furthermore, the area under the curve for combination of FRS and CACS was 0.936 (95% CI: 0.887-0.969, p <0.001), and this combination provided a better diagnostic advantage than either FRS or CACS alone (p <0.001 and p = 0.012 by C-statistic, respectively). Conclusions: In asymptomatic Taiwanese subjects with low to intermediate cardiovascular risk, both FRS and CACS were independently related to subclinical atherosclerosis. A combined FRS and CACS evaluation improved the efficacy of prediction for atherosclerotic plaque burden.