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April 21, 2004

Use of Coronary Calcification Scores to Predict Coronary Heart Disease—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(15):1831. doi:10.1001/jama.291.15.1832-b

In Reply: Dr Wierzbicki and colleagues suggest that inclusion of hsCRP might increase the predictive accuracy of the FRS to a greater extent than CACS. We have examined the relative predictive power of hsCRP and CACS1 and found that both hsCRP and CACS independently contribute to coronary event prediction. In response to their suggestion to evaluate the predictive ability of hsCRP level in addition to FRS, we calculated the ROC area for a model that includes FRS plus hsCRP level (ROC area = 0.64) and found that this model was not significantly better than FRS alone (ROC area = 0.63, P = .09) and had poorer discrimination than that for FRS plus CACS (ROC area = 0.68, P<.01). In addition, we note that use of risk models combining Framingham risk and hsCRP (or other factors) are neither standard nor widely available at present. However, we agree that they warrant further development and critical evaluation.

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